How Can I Keep my Skin Looking Youthful Without Surgery?

I really really don't want to get a facelift or anything close to plastic surgery. What surgery alternatives are there for sagging skin and rejuvenating skin damaged by sun and wind and general neglect.  I am 35 years old and already I look mid-40s...not good when you're still on the singles scene! I appreciate your answers.

Doctor Answers 10

Numerous ways to youthful skin without surgery

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First start with photoprotection. Chose a good sunscreen with moisturization rather than a moisturizer with some sunscreen thrown in.

You cannot do a thing about your genetics and what is called chronologic aging. If you take biopsies of buttock skin at age 20 and later at age 70 you will see degradation and changes in collagen and elastin, the two main ingredients of the matrix or framework of the dermis.

However, you can protect against photoaging.

There are two main wavelengths that affect the skin UVA and UVB (in the ultraviolet spectrum) (a recent paper in Nature that showed there is also damage caused by visible light but I won't get into that). UVB (290-320 nm) is stronger than UVA but it is more superficial. Brown spots, color irregularities, texture abnormalities result from UVB exposure. Also UVB triggers the mutation changes which cause basal cell and squamous cell cancers. UVA has a longer wavelength (320-400 nm) and therefore penetrates deeper into the skin. UVA is more responsible for photoaging (although it also contributes to skin cancer formation. It is much more abundant than UVB.
Most SPF (sun protection factor) indexes measure chiefly UVB.

The best sunscreens are what are termed physical sunscreens. These are zinc oxide and titanium dioxide. These are much less reactive, less irritating and less allergenic. They are more stable than their chemical sunscreen cousins. They work by deflecting UV radiation away from the skin. The UVB and UVA rays bounce off them. Some of you who are my age and perhaps a bit younger may remember people with the unsightly zinc paste on their face (it was de rigeur for lifeguards). Well, the technology has improved substantially and in recent years they have been micronized; chopped up into small fragments. These products are much more elegant.

There are a number of excellent physical sunscreens on market. These include Blue Lizard Sunscreen Sensitive SPF 30+, Colorescience Sunforgettable: Vanicream: Solbar Zinc; Oil of Olay Defense Daily UV Moisturization; Skinceuticals Physical UV Defense;Purpose Redness Reducing Moisturizer and Neutragena Sensitive Skin Sunblock.

Newer chemical sunblocks utilize a combination of UVA and UVB filters. These manufacturers usually use a UVA filter (Avobenzone and UVB filter (oxybenzone.) It has been much more difficult for the companies to find a good UVA blocker since Avobenzone is not so stable. Neutragena's addition of a chemical has caused increased stability in what they call helioplex technology. Aveeno uses the same technology in their products. I like Aveeno's Active Naturals Daily Moisturizing Protection SPF 15, Neutragena Ultra Sheer, Bull Frog Surfer Formula Gel ( for active people, not everyday use),Coppertone Sport Stick, Cetophil Daily Moisturizer,Ti Silk, Eucerin Extra Protective Moisturizing Lotion, and Anthelios SX.

Second, get a good antioxidant regimen going. From the inside and the outside. I did not mention this in the sunscreen area, but Skinceuticals makes a very nice product called C E Ferulic. I would apply this under either Skinceuticals moisturizer or another of the above mentioned brands. I also like the Neotstrata line since they are relatively inexpensive. Skin Rise Bionic Tonic by Exuvience is there best product in my opinion.
These are good day time options. At night I do not feel that there is too much better than RevaleSkin Intense Recovery Treatment. Its main ingredient CoffeeBerry is an extremely potent moisturizer. Prevage is also good with its Idebenone, but I have had too many people break out to this product. Aveeno's Ultra-calming cream with FeverFew is also excellent. This is not to be an exclusive list. There are many other very good antioxidants out there.

I, like nearly all my dermatology colleagues, believe in Retinoids. Applying one, I prefer Tazarac cream 0.1 an hour before your antioxidant turns on the Retinoid receptors and is most effective. Orally, I like the following antioxidants: Resveratrol, CoffeeBerry, Acai, Vitamin C, Lycopene, and Pycnogenol.

I too feel that Botox is very effective and may prevent future wrinkles by calming down the muscular contracture responsible.

Intermittant peels or microdermabrasion helps too.

IPL using the photorejuvenation settings is is also very helpful. Buying a package of 4 should be relatively inexpensive (about $600). Realize the mechanism is the destruction of collagen. Its reformation takes a couple of months so you do not see the benefit of this treatment until that time.

Do not smoke. You can find an impressive discussion of this online. Get plenty of rest so you do not develop bags under your eyes. Sleep on your back with your head mildly elevated.

I realize many of my colleagues recommend drinking plenty of water. This is not bad advice, but beyond the level of dehydration this was shown recently not to make much of a difference.

Relax if you can. Get a hobby. Stress ages your skin.

I hope this advice helps. (Also, realize I do not sell the above products aside from RevaleSkin).

Virginia Beach Dermatologist

Fillers, Resurfacing, Retin A, IPL, Botox, and skin care

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All of these options can help you maintain your skin without surgery.

Fillers: when you age you lose volume, and replacing this volume can do wonders to fill in the facial contours. This can get rid of general wrinkles and highlight the face in ways to bring youth to the face. Restylane, Juvederm, Perlane are hyaluronic acids and last from 6 months to a year or more. Radiesse is made out of bone and is very compatible and will last about a year. Artefiill is polymethametacrylate microspheres and is a permanent filler that is FDA approved for the nasolabial folds and can basically last permanently.

Resurfacing: is a way to remove wrinkles, make pores smaller, take away unwanted pigmentation and tighten the skin. Chemical Peels, CO2 laser resurfacing, dermabrasion, aggressive microdermabrasion, fractionated lasers can all do this to some degree. They can be tailored to fit your lifestyle and schedule. This is the only way to really improve the etched in wrinkles on the surface aspect while fillers can help do this from a deeper level. Fillers, however, will not change the surface charateristics as much as resurfacing modes can.

Retin A: can reverse skin damage, decrease your chances of skin cancer, improve fine wrinkles, decrease unwanted pigmentation in mild to moderate degrees. This is a topical medication and is available through prescription only. Retin A can also help with Acne as well. It is also used to prepare the skin for laser resurfacing.

IPL: Intense Pulse Light is light that is concentrated and filtered to allow a selected range of light to target pigements, brown spots, and vessels and the red spots they create. There is essentially no downtime with this treatment. It can also tighten your skin to a small degree. The reduction of the spots can really make your skin look clear and younger

Botox: makes the muscles in your face weak whereever its injected. When the muscles are weak they can't make wrinkles with the expressions. Botox can be injected in a directed manner to reduce the appearance of wrinkles!

Skin care is vital. Your skin protects your face and allows it to look the way it does. When you wash your face with harsh chemicals or expose it to the environment in a extreme way it will react with redness and hyperpigmentation. Washing with a gentle cleanser and only once a day max will help. Tanning is a no no and you should always wear sunscreen and apply it all the time. Staying out of the sun is also important.

Philip Young, MD
Bellevue Facial Plastic Surgeon

Botox, fillers, and Fotofacials

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• Botox – a must for prevention of frown lines, worry lines, and other expressive wrinkles
• Facial fillers – the most natural way to rejuvenate the aging face, without surgery
• Fotofacial – a non-invasive surface treatment for skin rejuvenation

Women over 40 may not necessarily need plastic surgery, but they typically can benefit greatly from facial fillers to treat wrinkles and to plump areas that have lost fullness with age. Our top 3 filler products are:

1. Perlane
2. Radiesse
3. Sculptra

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The most important advice for reducing the need for...

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The most important advice for reducing the need for cosmetic treatments is to reduce smoking and sun exposure. Botox and filler injections can reduce the signs of ageing in the 30s and 40s. Chemical peels can freshen the complexion if there are early signs of ageing.

I get my beauty rest, eat lots of fruit & vegetables...

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I get my beauty rest, eat lots of fruit & vegetables, drink plenty of water & use a broad spectrum sunscreen & anti-aging products. My favorites are Retin-A & Revaleskin.

Suzanne Friedler, MD
Manhattan Dermatologist

Look youthful without surgery.

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I frequently see patients in my office who tell me they just don’t recognize themselves in the mirror anymore. As they have aged these patients have developed wrinkles, saggy skin, less facial volume and uneven pigmentation. They often tell me everyone keeps telling them they look tired. Everyone ages differently. Contributing factors to aging are genetics, sun exposure, and lifestyle choices. Alcohol consumption, smoking, stress and getting enough sleep all play a factor.

For patients seeking facial rejuvenation, there are several non-surgical way to address the visible signs of aging.



Good skincare starts with a good medical grade skin care product.  These products can make the skin look its best and help lighten those dreaded pigmentation spots. In my office I carry the SkinMedica skin care line but there are other skin care lines that are comparable. Make sure you are using a skin care line that is 'medical grade' meaning it can only be obtained through a physician. 


After you've established a good skin care routine you might want add Botox to your regime. Botox can address crows feet and forehead wrinkles. 



Fillers are another line of defense against wrinkles. They are often used in conjunction with Botox. While Botox addresses the wrinkles in the upper part of the face and Juvederm addresses the wrinkles in the lower part of the face. Fillers can fill in where facial volume has been lost in the mid face, they can also fill in the other lines that form around the mouth region.

JuvedermXC and Juvederm Ultra XC are two very popular fillers made by Allergan.  A skilled injector can determine which of the 2 Juvederm products would be best suited to the patients needs. During the procedure the Juvederm, which is a jell, is injected into the face to smooth out wrinkles. The procedure takes about 15 minutes and last from 6 months to 2 years. 


Chemical peels are another popular way to make your skin look it's best by removing fine lines and fading age spots. A chemical peel is a quick 15 minute procedure. Your skin may be red and peel for up to a week after the peel but this can be disguised with a light foundation. 


If the patient further desires to take 10-15 years off of their face they may consider the surgical route and undergo a face lift, eye lift or a brow lift.

Focus on Cellular Rejuvenation

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Products containing Glycolic and Lactic acids are effective at cellular rejuvenation.
Retinol creams along with Vitamin C powder also provide excellent boost and exfoliation for the skin: sun spot reduction, fewer fine lines and wrinkles. For maximum effects the available options include laser treatments for collagen renewal. Injections and fillers are also a popular choice - Botox and Juvederm.

Young Looking Skin without Surgery

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There are a few ways you can help slow down the clock and even rewind it without surgery. Wearing sunscreen with at least SPF 30 is a good start. Botox and fillers such as Radiesse or Juvederm is another way. There are also laser resurfacing techniques that can greatly improve your appearance without surgery.


I think first and foremost have a good diet, drink...

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I think first and foremost have a good diet, drink plenty of water, do not smoke and use sun block to protect your skin. After that a good skin care regime along with simple procedures such as injections of Botox or something similar will help slow the development of wrinkles.

Vikram Vijh
London Plastic Surgeon

Botox is a fantastic way to give your face a more rested...

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Botox is a fantastic way to give your face a more rested youthful appearance with virtually no down time.

Laser hair removal is an effective solution for dark and/or ingrown hairs. It’s a great investment in smoother, hairless skin with only 3-5 treatments.

Intense pulsed light or IPL quickly gets rid of brown spots and red splotches on the face, and you can go to work that same day.

Michael Eidelman, MD
Manhattan Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.