I am spending this week in Boston because on this week of October16-20, 2015 about 2000 plastic surgeons from all around the world convene at the Boston convention center for our national meeting. This meeting is so big and has so much going on, it is just buzzing with exciting things.

Here, I have the opportunity to go to lectures that go on all day long talking about things ranging from reconstructive breast surgery to cosmetic facial and eyelid surgery. Also in the exhibit hall, all the companies that have products in the medical cosmetic market are here to show what is new and innovative in the world of cosmetic medicine and plastic surgery in general.

So in short, this meeting gives me and all 2000 of us who are here, the chance to catch up and see what’s new in plastic surgery and also to just go back and remind ourselves of what is the “tried and true”.

Because this meeting has so much to offer, it is impossible to take everything in…. not just because we have limited attention-spans and abilities to sit in lectures for hours on end, but because the lectures are occurring simultaneously in different rooms, so unless I get into the genetics of cloning and decide that the world would somehow be enriched by another one of me, I had to limit myself to one educational track. For this meeting, I decided to immerse myself in the art and science of facial rejuvenation.

All together, I sat through about 20 hours of lectures on different methods of facelifts, eyelid rejuvenation procedures, skin resurfacing and chemical compounds that maintain skin integrity. I even did a three hour dissection course on human cadaver heads so that I could go back and look at the anatomy again. I haven’t done that since my fellowship in plastic surgery at Emory University. It was a great course. We looked at the three dimensional anatomy of the face and reminded ourselves again where all the nerves were and did four different facelift techniques. I practiced some methods that I don’t typically do in my own practice to see if it could be maybe better than what I am already doing.

At the end of it, I want to tell y’all…..I can understand why someone may be confused about what they should do to stay looking young!! There are so many really good options and by the same token there is so much nonsense out there. It is hard enough for me after 4 years of medical school, 10 years of surgical training and subspecialized training in plastic and reconstructive surgery and 6 years of being in private practice to sift through the information that is poured on us through the media and very effective sales people who’s goal it is to make you believe that theirs is the magic potion or surgeons who have dedicated their lives to doing one sort of operation who’s legacy depends on their ability to pass the baton to us to continue doing things the way they have professed. I can imagine how hard it must be for people who haven’t spent their life studying this stuff to decide what to do.Is a laser enough to tighten my skin? Or is a chemical peel really better? What skin cream should I use at night? What about during the day? Can I look better with filler and Botox? Is fat better? Or maybe I need a facelift? What is a celebrity lift? What is a lunchtime lift? Who do I go to? When should I go? How far should I go?

Well, I can’t tell you I have come up with the answer that is going to fit everyone because every single person is different. We each have different aging challenges, we each have different goals for what we would like to change and we all have different budgets. What I want to do here is give you some tips about what I think are some of the winners and what are the losers in the world of cosmetic medicine.

So I came up with a grading system. It has levels and grades. The levels indicate how invasive the procedure is and the grade how effective the procedure is when considering cost, down time, pain etc. This of course is my opinion and is very subjective.

Level 1 are completely non invasive. In this level, we are going to discuss things we do in our homes like medical grade skin care, devices that are supposed to firm the skin, devices that exfoliate, things like that.

Level 2 are minimally invasive procedures. This category can get pretty big with everything that comes out on the market. It also is pretty difficult to grade because like anything else, sometimes when something is new, we need time to really see how well it works and of course if there are any long term consequences of the therapy either good or bad. In this category, I would put all the botox and filler procedures, skin resurfacing with lasers or chemical peels.

Level 3 are invasive procedures. This is surgery.

Level 1

Medical grade skin care

Your skin contributes so much to the overall appearance of age. The more bounce back and elasticity that you have in your skin, the younger you are going to look. If your skin maintains its ability to “deform” and then snap back, you are not going to sag as much, you will not have as many deep lines and furrows and your skin will appear smooth and youthful. To keep this elasticity, there are some things that you can do on a daily basis to prevent loss of elasticity and even restore that which has been lost (to a small extent).

SunscreenThe sun is an enemy to the elastic tissue in your skin. So wearing sunscreen every day is something we all can do. We all can afford it. There is no excuse. DO IT!!

Sunscreen gets a A+ grade.

Retinoids

Retinoids are vitamin A derivatives that you can use topically on your skin to help restore the collagen and therefore the elasticity in your skin. They have lots of other good effects, like helping to increase the turnover time of your skin, decrease acne breakouts in those prone and there is evidence that there may be some protective effect against some skin cancers in people who use retinols regularly in their skin care regimen.

Unlike sunscreen, which has no real drawback, retinols can be tough for some people to start using. This is particularly true if you have sensitive skin. It can cause dryness and irritation. Therefore when you embark on a regimen of retinol based skin care you should be followed by a physician, who can adjust the dose and frequency of use. This is why it is a prescription. Drug store creams with retinol in them don’t count. They barely have any retinol in them. You would be lucky if you got one drop for the whole bottle. You need a well defined dose and our goal is going to be to get you used to lower doses and increase this as tolerated. Once you do get your skin used to the retinol, and you find the dose that suits you, there really is no draw back to using it. It is only marginally pricey, but very worth the investment. So I also give retinol a very high grade.

Retinol gets an A grade.

To Be Continued…