What procedure(s) will erase the crepey skin on my cheeks? It makes me look so old. Mature, 57 year old. (photos)

Question

Along with procedures, which type of makeup provides the best coverage without looking older on skin like this?

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

"I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer."

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. Although I cannot offer much in the way of makeup advice, I can offer other solutions. I think the fine lines and wrinkles, as well as the quality of the skin would be drastically improved with some regular microneedling treatments as well as a medical-grade skin care regimen. In addition, I think the combination of some mid-facial filler (Juverderm Voluma) might help to elevate the skin and improve the position of the tissues. An in-person consultation would be needed to examine you and determine the optimal treatment plan.Hope this helps!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photograph. I like the results that the LightPod Era Erbium Laser gives. The skin is tighter, more elastic, less lines/ wrinkles and diminished sun damage. Recovery is quite fast with the erbium laser. I hope this helps. Good luck!

Brian Widenhouse, MD · Answer

Thank you for your question, as part of the aging process collagen and elastin production slows down resulting in thin skin with fine lines and wrinkles.  At Port City Plastic Surgery we recommend a series of Microneedling with PRP every month followed by a skincare regime at home that includes retinol.  Another modality commonly used is fractionated laser that can help improve the surface of the skin while stimulating new collagen growth. Combination therapies are always the best way to approach a loss of collagen and elastin in the skin.  Best of luck!

Yael Halaas, MD · Answer

As we get older, collagen production slows down, which cause skin to lose its elasticity. In turn, fluctuation in hormone levels can also cause a reduction in elastin. Retinoids or Retin A are topical agents that increase cell turnover. In addition, dermal fillers can restore lost volume and smooth out fine lines and wrinkles. Botox works well to eliminate lines around the eyes and in between the brows, as well as the forehead. CO2 lasering also works well to restore a smoother, more youthful appearance.

Cheree Dunbar, MD · Answer

For fine wrinkles and crepey skin, you will get the best results by combining procedures and using a high quality skin care product.  Crepey skin is a result of thinning of the skin and loss of collagen and elastin.  A series of fractional laser treatments will improve collagen and skin thickness.  An RF treatments such as Exilis Ultra 360 (which combines RF and ultrasound) will also help to improve elastin and tighten the skin.  Finally, there are a variety of skin care products that can also help.  My favorite is DEJ face cream by Revision Skin Care which helps the skin look younger over time.

Jacqueline Bearden, MD · Answer

Great question that effects many women. Fine lines and crepey skin needs a multifactoral approach and the approach may depend on how much downtime you can afford.  Start with good skin care using exfoliating products such as AHAs and retinol, this will treat and prevent.  Resurfacing lasers using CO2 or erbium Yag energy is a great way to soften and eliminate lines but has considerable downtime.  Radiofrequency treatments, chemical peels of different strengths can also help.  Make up can't eliminate the lines but certainly can worsen the appearance.  Pure mineral makeups with light coverage work the best as heavier products will fill in the creases and weigh them down. Hope this helps!  Jacqueline Bearden MD

Leonard Grossman, MD · Answer

Thanks for the question. There is practically no makeup that will make the skin look better, in fact I'll probably enhance the appearance of the wrinkles. What you see on TV is only TV, since these people have super bright lights which make them look better and they will sell you anything making you believe it actually works. There are many approaches that you can use for your skin Improvement. You can start with something like a combination technique of a mild chemical peel that you can do at home by yourself using Retin-A and Alpha hydroxy acids in combination with some vitamin C cream for better healing. If you want to be more aggressive you can either have perioral dermabrasion which is like using sandpaper and removing old skin and that will expose brand new skin in return. Or you can have an even more aggressive procedure using the Renuvion or j-plasma skin resurfacing technique. Good luck from New York City

Robert T. Buchanan, MD (retired) · Answer

Crepey facial is caused by an interplay of the skin and the underlying muscles. As we age, the skin stops producing both collagen (the substance that gives the skin its thickness and strength) and elastin (the substance that makes the skin elastic). Both usually happen before we are 30. With both collagen and elastin present, the skin contracts and then resists further muscle pull. With loss of them, the muscle over pulls the skin and causes it to pleat. With time, the muscles also hypertrophy and pull harder. There are several things that can be done to improve this. If the muscle can be weakened, like around the eyes with Botox, the process can be slowed. You can also slow the process and even reverse it by adding collagen and elastic tissue to the skin. Collagen can be added by use of tretinoin (Retin-A) or by microneedling. I prefer tretinoin regularly. Elastin can be added by use of Obagi's ELASTIderm. At your stage. there are 2 things you can do to improve the problem faster. One is laser resurfacing. This, however, has a prolonged recovery. The other is to fill the depressions with a filler like Juvederm Volbella and then criss-cross it under the dermis to stiffen it. This also helps the tretinoin to work since it can use some of the hyaluronic acid to convert to collagen (something now proven to happen). Make sure you see a skin care specialist skilled in all these modalities.

What procedure(s) will erase the crepey skin on my cheeks? It makes me look so old. Mature, 57 year old. (photos)

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