On Your Health

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An INTEGRIS Surgeon Discusses Safe, Nonsurgical Anti-Aging Treatments

Open a magazine, turn on the television, read a blog or log in to your social media. If you’re a woman, especially if you’re “of a certain age,” you’ve probably noticed you’re being targeted. Smooth this, firm that, tone this and take these supplements for younger looking skin. Dr. Scott Shadfar, a dual board certified otolaryngologist and facial plastic and reconstructive surgeon at INTEGRIS ENT and Facial Plastics and Aesthetic Institute of Oklahoma, explains which treatments are safe and effective.  

Dr. Shadfar earned his medical degree from the University of Oklahoma College of Medicine and completed his otolaryngology surgical residency at the University of North Carolina. Following his surgical residency, Dr. Shadfar completed further specialty fellowship training in facial plastic and reconstructive surgery. In his practice he also offers nonsurgical, minimally invasive anti-aging treatments.

Shadfar is a data-driven doctor, which means he only offers his patients the most proven, safe and effective treatments. ‘The latest craze’ will only impress him if the science and data behind it are unimpeachable and unequivocal. He encourages people to be very careful in choosing a physician or treatment, especially when it comes to facial procedures. “You can’t put a bra on your face,” he says, meaning there’s nowhere to hide if a poorly-researched treatment does not work out the way you hoped.

On a day-to-day basis, Shadfar recommends a simple, consistent routine. “You need a good cleanser, moisturizer, sun block, a retinol and a serum. Topical retinoids are fabulous, and the growth factors in physician-dispensed serums stimulate the skin in such a way that it heals itself. They are 95 percent proven,” he says.

Recently, we sat down with Dr. Shadfar so he could demystify a whole slew of treatments and let us know which ones he considers safe and effective.

Ingestible collagen supplements: do they actually improve the texture and look of skin?

“This is a complex question. Skin health has primarily been achieved in the form of topical application of dietary supplements (vitamins, polyphenols, micronutrients and proteins). The general population is comfortable applying these treatments in this manner, and the manufacturers have substantial experience formulating ingredients through this route,” says Dr. Shadfar.

“Oral supplements and ‘nutraceuticals’ (this is a broad term combing two words – ‘nutrient’ and ‘pharmaceutical’ – used to describe any product derived from food sources with extra health benefits in addition to the basic nutritional value found in the foods) are classified as dietary supplements, and the FDA regulates dietary supplements under a different set of regulations. This opens up a completely different conversation regarding the quality of the product ingredients, the manufacturer, and potential of contaminating substances,” he says. 

The bottom line? Says Dr. Shadfar, “It sounds fabulous and convenient, but data is not yet available that proves whether compounds like collagen hydrolysate are efficacious, appropriately dosed, well-absorbed and might positively impact skin health. There are some promising results showing improvement, but to comprehensively study the different benefits of these types of compounds on skin, I feel controlled clinical trials are still needed.”

Retinoids and Retinols 101: What are they and what do they do?

"Retinoids and retinols are both derivatives of vitamin A and often we group them into the all-encompassing category of 'retinoids.' In the skin they are converted to retinoic acid, which has been proven to improve fine lines, hyper-pigmentation and to rejuvenate the skin. The basic difference has to do with their respective concentrations. Retinols are suitable for over-the-counter formulations in various creams and lotions, while retinoids have a much higher concentration and are prescribed by physicians. Determining which is more suitable for you should be discussed with your physician based on your goals of treatment, skin type and age." says Dr. Shadfar.

“Retinoids come in different formulations (gels, creams), concentrations, and can even be administered orally (Isotretinoin or Accutane).  The newer generation of medications (Tazarotene and Adapalene) are generally stronger, and are used to treat more severe forms of acne,” Shadfar says. 

He is a fan of retinoids and recommends them as a part of daily skin care. “Ultimately, from a cosmetic standpoint, retinoids have been shown to increase the ground substance necessary for cell turnover, stimulate collagen-producing cells and act to decrease the enzymes that break down collagen. This means, as a patient, you benefit from smoother, glowing skin, with a reduction in fine lines. That is the optimal result from a retinoid.”

Retinoids can be uncomfortable at first, and that’s normal. Results will outweigh initial discomfort in the long run. “The best concentration of any retinoid is a balance between efficacy and side effects. Universally, patients will experience skin sensitivity with redness, peeling, and a chapped feeling depending on the concentration and absorption of the topical preparation (gel, cream or foam). Spacing out the application every other night can make the treatment more tolerable,” he says. 

The severity of the side effects does subside over time and sticking with it is important. “I tell my patients to mix their retinoid with a nice moisturizer when applying it, wear sun block during the day, and to make sure they avoid sun exposure, which can make the side effects worse.”  

Injectables and fillers: Are they safe?

The appearance of wrinkles, whether static (wrinkles seen at rest) or dynamic (wrinkles seen when smiling or frowning), come naturally as we age. “Botulinum neuromodulators, marketed under brand names like Botox, Dysport or Xeomin, are injectable products used to induce controlled weakness of the muscles that lead to these wrinkles and lines,” says Dr. Shadfar.

“My goal with botulinum neuromodulators is to use the least number of units necessary to achieve a natural result,” he says. He adds that the old way of administering these treatments eliminated animation, which did not look natural and discouraged many people from giving botulinum neuromodulators a try.

Shadfar says more than seven million injections were performed last year, and they are becoming increasingly common in a younger patient population as well, although “I generally recommend these injections be reserved for clients who are noticing the lines sticking around at rest and not just with motion,” he says.

“Injections with these products are generally well-tolerated and side effects are few, such as mild swelling and/or redness in the treatment area; but these symptoms should dissipate relatively quickly, and most patients resume regular daily routines immediately. The results tend to become apparent within one week, and the effects typically last about three months.”

Fillers, on the other hand, don’t weaken the muscles around wrinkles or lines, they are used to fill those lines. Dr. Shadfar thinks fillers are a good option for patients who are interested in plastic surgery but aren’t quite yet ready for it.

“Fillers are different compounds used to restore volume, camouflage, fill lines or augment the tissues to turn shadows into highlights in areas of the face such as the cheeks, temples and lips. Fillers can be injected in the office with topical anesthetic cream, although most patients don’t require the anesthetic,” says Dr. Shadfar.

He continues, “Depending on the site of treatment, there are several types of fillers that can be used. However, I only recommend temporary fillers such as hyaluronic acid fillers from the Juvéderm or Restylane product lines.” Dr. Shadfar says these offer a lower risk of complications and can be easily dissolved if needed. Like botulinum neuromodulators, filler injections also have minimal downtime.

His caveat: “These are becoming increasingly available at beauty spas and offices. However, I still advise all patients to find an expert who has a precise knowledge and understanding of the functional anatomy of the facial muscles, such as a board certified facial plastic surgeon.”

Laser skin resurfacing procedures: What’s the difference?

Dr. Shadfar says skin resurfacing procedures can be divided into ablative and non-ablative. “The ablative lasers, such as the Erbium or Carbon Dioxide (CO2) types, use controlled wounding to remove the outer layers of the skin. It is this wounding and healing process that induces the skin to heal and reorganize, while increasing collagen production. These are great modalities to reduce visible signs of aging, acne scarring and pigmentary irregularities,” he says. “The results can last for years, although patients should be aware of the downtime associated with ablative type lasers, which can range from five to 10 days dependent on the depth of treatment.” 

Conversely, Dr. Shadfar explains, non-ablative lasers use energy to heat the skin without injuring the top layers, minimizing the downtime and recovery associated with treatment. Non-ablative lasers still allow improvements in skin texture and fine lines with smaller risks; however, multiple sessions are often required, and the results do not last as long.

“Photofacials are a popular type of non-ablative laser treatment using intense, pulsed light to target dark sun spots (hyper-pigmentation), broken blood vessels, active acne and blotchy skin. This is a very popular treatment because it has minimal discomfort, with little to no downtime,” he says.

Is there anything nonsurgical that can firm up a sagging neck?

“I often get this question. I tell my patients there are several non-invasive options using ultrasound technology, like Ultherapy, or radio-frequency devices such as Thermage and Thermitight. Unfortunately, what most patients should keep in mind with these devices is the outcome is not predictable. It is not guaranteed that a patient's skin will respond well, or to what degree he or she will see benefit,” Dr. Shadfar says.