Considering aesthetic enhancement

This is usually the part that gets patients most excited, so here is Dr. Grossman’s take on aesthetic enhancement:

Less is usually more.

If you get a natural-looking result without any telltale signs of having had something “done”, you’ll never go wrong. That said, not all procedures are indicated for all patients. We’ve all heard about people having bad experiences — sometimes facing a lifetime of scarring or worse — because due diligence wasn’t performed. Though many aesthetic enhancement procedures can be relatively fast, simple, and painless, they’re still medical procedures, and should therefore be addressed as such.

Once Dr. Grossman knows your goals, she can discuss the best strategy for achieving them and fully educate you on why she believes her chosen strategy will work. Often, a patient is mistakenly convinced that they need a more aggressive procedure than they actually do — but a more simple, non-invasive treatment will achieve their goals more appropriately.

This is where education comes in. Dr. Grossman will take the time to go over all of your available options, fully informing you on how they work for the aging face and how they will suit your specific needs. Or, if a combination of treatments will offer the most impact, she will educate you on how they work together.

Step 1: Into the Looking Glass

After taking a thorough medical history, Dr. Grossman will hand over a mirror to you and ask, “What’s bothering you?” You can then show her exactly which areas you’d like to change. This exchange sounds simple enough, but it’s hugely important. While Dr. Grossman considers herself to have an experienced aesthetic eye, your main concern may surprise her. For example, she had an elderly patient who had significant lines around her eyes and bags underneath, but what troubled the patient most were the fine lines on her upper lip. The shaded glasses she wore on a regular basis covered her eyes, so she didn’t even care how they looked!

Customized Facial Rejuvenation at Grossman Dermatology

Step 2: Let’s Talk Aging

Before exploring treatments, we will look at how your particular face and skin are showing your years. It’s important to understand that while no one escapes this inevitable slide, everyone ages at different rates and in different ways. A thorough explanation from Dr. Grossman in front of the mirror will help address your detailed concerns without losing sight of the big picture.


What happens to texture and tone

If you’re serious about anti-aging, you absolutely must stick with using a topical antioxidant and broad-spectrum sunscreen every single day, because several negative things happen to skin over time — and sun exposure hastens everyone. First, the skin begins to lose its luminosity and smoothness. With less light reflecting from its surface, dullness takes hold. Stubborn sunspots appear and broken blood vessels may form, particularly on the nose, cheeks, neck, and chest. (Want a clear picture of the havoc that UV rays can wreak on your skin tone? Simply compare those areas to the skin from a zone that is never exposed to the sun, such as your breast or buttock.) Lines also begin to develop. Some lines — such as horizontal creases across the forehead, crow’s feet on the sides of the eyes, and squint lines between the brows — are exacerbated by motion in these areas. Smoking (past or current) worsens lines above the upper lip, and sunlight turns skin crepey under the eyes.

What we can do to help:

  • Dr. Grossman is a big fan of the new ActiveFX™ laser, the gold standard for correcting almost everything, from fine lines to deeper creases, sunspots to sagging skin. This non-ablative laser produces similar results to more aggressive ablative lasers (such as the CO2) without the downtime associated with those. In the high-tech, anti-aging arsenal, the ActiveFX laser is a truly remarkable weapon.
  • If you want gentler options, you might consider Fraxel® lasers (which are great for evening out skin tone and texture and minimizing pores) or intense pulsed light therapy (which can erase broken blood vessels and brown spots).
  • Motion lines are best treated by botulinum toxin (Botox®, Dysport®, or Xeomin®), a chemical that blocks the connection between the muscle and the nerve, thereby decreasing the offending motion and the wrinkles it creates.
  • At a minimum, a customized, at-home skincare regimen — which may include peptides, antioxidants, and retinoids — can help brighten skin and soften the appearance of fine lines, age spots, and enlarged pores. And sunscreen, the ultimate anti-ager, is key. The right skin care will ward off further damage, help you maintain your new and improved complexion, and pave the way for smoother, younger-looking skin.

The Sagging Face

Eventually, gravity takes hold for all of us. Eyebrows begin their downward drift. Below the eyes, fat can bulge into “bags”, making you look constantly tired. The face and cheeks can also droop, creating deeper nasolabial folds, marionette lines, and jowling along the jawline. In addition, the neck can become loose, developing vertical bands or a pocket of fat underneath the chin.

What we can do to help:

  • FaceTite™, NeckTite™, and AccuTite™ are powerful radiofrequency devices designed to help tighten the lower face and neck area. A small incision is made just large enough to insert the laser-containing cannula, and excess fat is melted then and removed beneath the skin. The skin is also lasered from underneath to stimulate collagen production and tightening.
  • Neck liposuction is also a fairly simple procedure that can offer a tremendous improvement, restoring a youthful, crisp jawline.
  • Thermage® can improve jowling, tighten up the neck area, and/or elevate the eyebrows. This treatment signals cells to produce new collagen over time, making it ideal for lifting and tightening the skin with no downtime at all. Thermage’s lifting effects have made it a favorite treatment of famous beauties like Gwyneth Paltrow and model Linda Evangelista, but many regular people — Dr. Grossman included! — love this procedure for its youth-holding powers.
  • The Forma laser is excellent for maintaining the skin you have and preventing sagging. This laser uses radiofrequency in a gentler, milder way to keep your inner collagen machine humming along.

The Sinking Face

If you’ve ever seen a caricature of an old witch, you’ll notice that her face looks sunken and hollowed out. That’s because this actually happens with age. Sometime around age 35, weight begins to diminish from the face. Nasolabial folds develop from a combination of sagging and sinking, cheekbones become more prominent, and the chin becomes pointier. Meanwhile, our lips begin to lose their sexy fullness. This is where Catherine Deneuve’s famous line comes in: “At a certain age, you have to choose between your face and your rear.”

Up until now, in order to keep our faces looking taut and toned, most of us have had to maintain a higher percentage of body fat than we’d like. But no longer. Now you can enjoy a youthful face — and a trim, fit body, too!

What we can do to help:

Sinking-related issues can often be fixed with injectable fillers. Many people worry about which type of filler to use, but Dr. Grossman believes that it's more important where the filler injected. She uses a wide variety of different fillers depending on a patient’s specific needs. Where and how much filler chooses is what matters most. The goal is always to replace lost volume and restore the face to its naturally attractive, youthful contours.

Skin Check and Skin Care

Dr. Grossman’s approach? It all starts with a skin health check.

As a board-certified dermatologist, Dr. Grossman believes that the most important aspect of a patient’s initial consultation is evaluating their skin’s health. This is why she performs a head-to-toe full body skin check (approximately 30 minutes) for each patient she sees. From there, she will talk about your perceived cosmetic imperfections and the options for correcting them. Dr. Grossman's patients all end up grateful to have learned the true health of their skin.

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Step 3: Making a plan

The best decision is an educated one that lends you peace of mind.

For example, if a patient asks for laser resurfacing when what she really wants to address are deep nasolabial folds and sunken cheeks, Dr. Grossman will take the time to educate the patient. After discussing the aging process in the mirror, the patient will understand why laser resurfacing won’t correct that problem, but something like fat injections will. 

While always keeping your concerns in the forefront, Dr. Grossman will occasionally offer suggestions if she feels that they will make a significant difference to your outcome — but ultimately, you make the call. Dr. Grossman will never “sell” procedures to her patients; a rule that they appreciate. The point is, once she has shared her extensive knowledge and understanding of all the available technologies, it’s your job to process the information and decide what’s best for you. 

Sometimes just a single procedure can help achieve your desired goals. Other times, it may take a combination of treatments to get you there in a beautiful, natural-looking way. We’re always here to work with you and help you get the results you want.

Dr. Karyn Grossman, MD

Meet Dr. Grossman

Karyn Grossman, MD, is a Harvard-trained, board-certified dermatologist in Santa Monica, CA and Manhattan, specializing in cosmetic dermatology. Her areas of expertise include Kustom Karyng treatments, minimally invasive lifts, suture-based lifts of all types, skin tightening, laser and energy-based device treatments, fillers, neuromodulators, liposuction, and body contouring treatments.

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