How to prioritize when you have multiple prevention and aging issues to address. Part 2 of 2

Dr Irwin, thank you for taking the time to answer my question. I am 79 and have normal to dry skin. I have been using Retin every other night and have had no problem. Should I be using an exfoliator like Biologique P50W to start and then move up. Or just a hydrating toner instead, or both. I use HA5 with DML Forte over it. I don’t feel my skin looks as hydrated and moist as it should. I am also doing a double cleanse at night and nothing in the morning. Should I add or take away from this routine? Thank you for any help you can give. Arleene

If you haven’t done the “homework” in Part 1, you might want to because it will help with Part 2. Now you have a list of 3-5 priorities based on what you did in the prior section.

Next you need a budget. Realistically, you’ll need about $1,000-1,500 (or about $100-$200 a month) for great skincare products. To me, it doesn’t make sense to spend on procedures like lasers, Botox/Dysport, fillers or RF devices and then skimp or not do much for prevention to preserve those gains.

Truly great sunscreens with high zinc oxide content, antioxidants, growth factors, niacinamide and pigment regulators, etc. really do make a difference over time. My vote is to spend here first, and then spend on repair and higher level procedures.

Costs really vary by area with large cities usually being more expensive.  Please don’t just look for cheap. Key always is the expertise of your doctor, mid-level, or nurse provider so do due diligence!

Next steps to make progress toward skin confidence:

So let’s say your list is: 1. Brown spots on face and chest, 2. Mild sagging at the jowls and 3. Upper lip lines and that’s the correct order for what’s bothering you. You can always re-prioritize to fit your budget better.  These are examples of how to think about it.

  1.  For lighter brown spots on the face and chest.  Think about IPL (needs to be done correctly) over both areas for 3-5 treatments. Or if the brown spots are deeper and more “roots” then consider Fraxel Dual with both heads, use 2 treatments.  Total cost for the series would generally range from approximately $1,500 to $3,000.
  2. Mild sagging at the jowls.  Sometimes a “lift” can be accomplished with just some filler in the upper face. Longer lasting fillers should last 6-12 months before being about 50% gone and needing a refresh with costs approximately $1000-$3,000 depending on age and volume loss usually. Or you may want to consider more permanent lifting with deep RF like Profound (need 400-600) pulses usually (but more expensive), at $4000-$5,000.
  3. Upper lip lines. These are in some ways tough to manage well and expensive. But ….a tiny bit of Botox/Dysport can help prevent progression and soften these. You’d add that to another area like the forehead, so expect to spend $300-$600 depending on what the minimum charge is for that clinic. Most effective is a combination of Botox/Dysport, filler (the lighter ones) and laser.  Costs need to be customized but $3,000-$5,000 for all three might be doable, with a little Botox/Dypsport needed 2-3 times a year for maintenance.

I hope this helps,

Brandith Irwin, MD

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