The subject of skin rejuvenation can be overwhelming. Breaking it down to the most common treatment categories hopefully provides a general understanding of the process. Of course, scheduling a consultation gives you a personal plan of action.

These considerations should be made before coming up with a plan of action:

SPECIFIC CONCERNS (aka What bothers you the most?)

Is that a scar between your brows or are you just plain angry all the time? Are friends beginning to ask if you should even be driving because you look so tired? Is your skin so dull and lifeless you actually yawn when you look in a mirror? Do you have resting frown face? Flattened cheekbones? Deflated cheeks? Withering lips? Dark spots? Broken capillaries? Deep folds? Weak chin? Double chin? Jowls? Crepey skin? Wrinkled neck? and the list goes on…

LIMITATIONS (any parameters you may have in regards to downtime, time frame, and budget) 

It usually takes time to see the end results of most lasers. So, if you have a big event (like your own wedding in a week), and you want dark spots to be vaporized on your face and shoulders, plan way ahead.

Or, let’s say you are chairing a gala on Friday, and you schedule a filler appointment on Wednesday, but don’t want to bruise. We’ll do our best, but 

Even when using microcannulas and our x-ray vision vein tracing gizmo, Accuvein, bruising can still happen. Because of these measures, chances of bruising are greatly reduced but cannot be guaranteed. (Maybe if you light a candle and say a prayer…)

Of course, there also are a few things patients can avoid taking for about 10 days prior to injections to impede bruising. The list of the major supplements/medications to avoid: 

Aspirin, NSAID’s (Alieve, Motrin, Ibuprofen, etc.), fish oils, Omegas, flaxseed oils, Vitamin E, Ginko Biloba, Glucosamine, St. John’s Wart and garlic. 

Additional tips: EAT PINEAPPLE for a few days before injections. Pineapple is loaded with bromelain, an enzyme that has super anti-inflammatory properties which inhibit bruising.

In regards to budget limitations – no shame here. We get it. Still, having a plan to reach goals sets things in motion. At tortoise or hare speed, we’ll help get you there. (One great way to save $$$ – Sign up for our newsletter for amazing discounts and specials.)

Before discussing the most popular menu items for facial rejuvenation, let’s talk EXPECTATIONS. The endless stream of information on the subject of facial rejuvenation can be overwhelming for all of us. Knowledge and experience allows us to separate “possible” from fantastical. For instance, “glass skin” likely will never happen for a lifelong smoker with sun damaged skin. (Please be assured, squashing these dreams brings me no pleasure.) Expectations and reality must be made clear.


In no definitive order. Individual needs vary. No two faces are alike. Cultural ideals of beauty and preferences exist.  Also, a combination of treatments is likely required for optimal rejuvenation and maintenance.

  1. LASERS and IPL

Anything you can do to improve skin quality should be a priority, and lasers are one of the most effective ways to rewind the ravages of time and sun damage. The two basic categories of lasers are Ablative and Non-Ablative.

Ablative lasers vaporize controlled layers of skin while heating the deep layers where collagen, elastin and tissue are induced to produce new skin cells and smoothing skin surface. Recovery time (a month or longer) and risks (pigment changes, infection, scarring) increase with depth and surface area removed, but so does the degree of expected improvement, especially in regards to skin texture (wrinkles, laxity).

Fully ablative lasers are not appropriate for darker skin types. Fractionated lasers, such as Pixel, may be used on darker skin types if skin is prepped with topical pigment suppressants about a month prior to treatments.

Non-ablative lasers are usually appropriate for all skin types. These lasers bypass skin surface, working their magic on the deeper layers of skin to smooth, tighten and clear. Multiple sessions are required for optimal results, but the trade offs are worth it: 

little to no downtime, few risks and great results.

Laser Genesis and Excel V are great examples of non-ablative lasers that target vascular issues (facial flushing, broken capillaries, spider veins, diffuse redness, etc.). These lasers also are effective in reducing pore size by decreasing sebum production, smoothing skin surface via collagen remodeling as deep layers are heated, clearing some types of acne, and improving overall skin health.

IPL, AFT, Photofacials are intense pulsed light devices/treatments that are ideal for shattering pigment from general sun damage and for reducing redness caused by acne, rosacea or sun damage. The number of required treatments is dependent upon the extent of damage/issues, general skin condition and desired degree of improvement.

IPL is NOT an appropriate treatment for darker skin types or for treating pigment issues such as melasma.


Chemical peels can seriously improve skin’s appearance from head to toe. 

Results, like most all treatments, are dependant upon the experience of the person performing the treatment. With chemical peels, this difference can be compared to an experienced master chef versus a fast food cook. Years of hands-on experience is required to know how different acids and concentrations respond to skin of varying degrees of health, skin types, different areas of the body, and which acids are most effective and safe for specific skin issues. Risks are high in inexperienced hands, but in the right hands, chemical peels just may be the key to perfect skin.

The list of benefits of chemical peels is a long one:

  • Improve color, clarity, tone, texture
  • Clear breakouts
  • Clear discoloration from general sun damage, PIH from acne or trauma (aka post-inflammatory hyperpigmentation), melasma, etc.
  • Soften surface scars and other visible imperfections
  • Smooth skin surface – reducing crepiness, lines and wrinkles
  • Remove layers of damaged, dead skin to reveal healthy, glowing skin

3. MICRONEEDING – SkinPen or Secret RF

#1 reason to fall in love with microneedling (medical): 

Significant and visible results for a wide range of skin issues (laxity, tone, texture, scars, wrinkles, stretch marks, etc.) with little to no downtime, and safe for all skin types. 

As stated in a press release from the American Academy of Dermatology, microneedling can improve “large pores, fine lines, wrinkles, scars and stretch marks.” This release also states roller devices for home or spa use can’t deliver the same results as microneedling treatments from a doctor’s office. 

SkinPen by Bellus Medical is the device we use in our office. It is the first and only microneedling device to be FDA approved to treat scarring. To boost results for a variety of issues, we oftentimes use SkinPen to deliver topical medications such as retinoic acid or TCA deeply into skin. TCA CROSS following SkinPen treatments also can boost end results in treating ice pick scars.

Secret RF uses microneedling to deliver radiofrequency energy to targeted depths and heating these targeted depths to specific temperatures. Secret RF is a superior treatment for skin tightening and in treating many types of scars. Results of a single Secret RF can equal the results of 5-10 regular microneedling treatments. Further, results rival those of most laser resurfacing treatments, without the risks, downtime or other limitations.

(Side note: Secret RF also can be used to treat festoons and for hyperhidrosis.)


Did you know Botox is one of the most injected products on the planet? For decades, Botox was used medically to treat migraines and facial ticks even in small children before ever crossing over to cosmetic uses. Botox now has become one of the safest and most popular treatments for facial rejuvenation. (YAY!)

Botox is most popularly used for upper face issues such as forehead lines, drooping brows, crows feet and frown lines. These “etched” lines form because of repeated and unconscious muscle movement (think of folding a piece of paper over and over along the same line). To release the crease, the action must be eliminated. [Enter Botox]

Botox also is used to treat upper lip lines, lift corners of lips, lift nose tip, and smooth dimpled chins. Other popular treatments include Botox for facial slimming, teeth clenching (bruxism), smoothing platysmal bands in the neck, hyperhidrosis, relaxing some types of scars, and at micro-doses, Botox can be used to shrink pores and soften surface lines, such as smile lines and chest wrinkles.

(You’ll never guess where Botox is made and the lengths taken to ensure its purity and safety. Find out here – absolutely fascinating.)


Nothing can offer immediate rejuvenation like dermal fillers.

The grand descent of skin with formation of jowls, marionettes, deep nasal labial folds, under eye hollows, sunken temples, lowered brows, longer forehead, receding chin, flattened cheeks and cheekbones, shriveled lips happen with time and a diminishing support structure (aka volume loss in facial fat pads, skin density, and bone loss).

When volume is replaced skillfully and thoughtfully in facial areas, beautiful and natural rejuvenation is the end result. Generally, upper face improvement with Botox for forehead lines, brows and crow’s feet is followed by filling temple hollows. Filling temple hollows improves general facial contours and positioning of brows. It also smooths the transition to cheekbones and helps draw light around eyes (concave=shadows=old; convex=light=youthful; bulging=too much filler).

Mid-face correction generally is the area that makes the most significant impact in facial rejuvenation with fillers. Treating the mid-face (cheeks, cheekbones, lateral facial areas) improves both upper and lower face by addressing tear trough depressions, refining facial contours, lifting nasal labial folds and marionettes.

If needed, lower face correction and refinement can be achieved with fillers (lip augmentation and definition, jawline enhancement, chin augmentation, marionettes, etc.). There also are treatments such as Kybella or truSculpt 3D to reduce jowling and double chins.

The goal of facial rejuvenation with facial fillers should always be to maximize individual beauty with respect to individual preferences. Natural rejuvenation with fillers requires more than technical skills; it also requires artistic sensibility and, oftentimes, restraint.

(Lack of restraint = overdone, unnatural, distorted, outdated.)


How we take care of our skin every day is the most important thing we can do for skin health and maintenance of treatment results.

While there are many wonderful OTC products, only medical grade and prescription products can be truly therapeutic. If you have skin issues (too long to list but includes acne, rosacea, melasma, sun damage, etc.), you either can continue grasping at straws, hoping the ads are true and your OTC products clear, smooth, control your issues, or you can switch or add a few medical grade products or prescriptions.

Read about some of our fave products here.

Here you have it: The Basics of Skin Rejuvenation. 

Important points: 

  • Skin health is key to successful rejuvenation (fillers and Botox rarely can do all the work).
  • What bothers you the most should be the first issue addressed (or you won’t be happy).
  • Successful end results take time. It is not a race. Starting earlier than later is great advice. Slow and steady usually yields the best results.
  • Balance.
  • Products matter.