10 Questions for a Dermatologist: How to Slow Aging

Putting your best face forward is important for your self-esteem but also for your long-term health and wellness.

We asked Toronto-based dermatologist Dr. Fred Weksberg his thoughts on over-Botoxed celebrities, if facials really work, the best ways to slow the affects of aging and more.

Get his expert skin-care advice after the jump.

Q: What’s the most important thing people can do to slow the affects of aging on their face?

A: You can`t really affect the affects of aging from genetics, but you can affect the other things which effect aging. The most important factor is the amount of sun exposure that you get. That’s the number one thing that increases your aging. The reduction of sun exposure and the use of sunscreens is probably the most important thing. Other things that are very important are using antioxidants, which are available in a wide variety of creams nowadays. Smoking ages your skin faster so obviously not smoking. Dry, skin, not taking care of it, also adds to aging.

Q: Do you have specific products that you recommend for acne-prone skin, dry skin and combination skin?

A: For acne, you’ll want to start using a topical antibiotic, which you will need a prescription for. If you want to use something more simple, there are a variety of different things you can buy over the counter in the pharmacy. Something very nice and light is called Solugel – it’s available over the counter and is a 4% preparation (a type of benzel peroxide.) Anything up to 5% is available over the counter and anything beyond that, you’ll need a prescription. There are stronger and more drying preparations depending on the severity of the acne. So then we’ll go to stronger concentrations or we’ll go to Retin A or Vitamin A acid. A common topical antibiotic which is widely used is called Clindamycin and that’s given to you in a lotion form. And then there’s various kinds of pills for treating acne.

For a moisture problem on the face generally we’ll go with a light moisturizer because if you go with something too heavy you might induce or cause an acne problem. On the body, it’s a little bit more forgiving and you can go with a thicker moisturizer there. A medium moisturizer would be something like Glaxal Base, which is a cream. If you want to go with something lighter, which people most of the time use, you can go with Lubriderm lotion or Cetaphil lotion. There are all kinds of lotions on the market. Some from the big cosmetic companies, like Clinique, are generally much more expensive than the ones from the pharmaceutical companies that you buy in the pharmacy and very often there’s no real difference apart from price and packaging.

If you have acne-prone skin and you want to moisturize, you have to be very careful not to use too much as that will aggravate the acne. In that case, I generally discourage my acne patients from putting on moisturizer even if their skin is dry because the acne treatment causes their skin to be dry and we want their skin to be dry in order for the treatment to be effective. But if they are too dry and they really can’t stand it then we’ll give them something very light. In those cases, I suggest a Moisturel lotion. The Moisturel lotion works really well for people with combination skin who are oily through the T-zone.

Q: What are the biggest do’s and don’ts with regards to skin care?

A: The most important thing to do for your skin is to use sunscreens. That’s number one. Beyond that you want to take care of your skin and if it’s got some eczema or acne, you’ve got to treat it because acne, for example, will lead to scaring in many cases if it’s not treated. You want to be proactive instead of retroactive. Take care of the skin whether it’s eczema (they might need a mild cortozone cream) or if it’s acne, they’ll need acne treatment or if it’s simply dryness, just use a moisturizer.

Q: Spas often sell facials as the best way to get glowing skin. Do they really make a difference?

A: Most of the time, what they are using are non-medicinal ingredients, in other words, these are things that are not by prescription. The way I look at going to a spa and having a facial done is you’re going there to get pampered and enjoy yourself and someone is massaging your face and they’re putting nice soothing creams on you and it feels good and they give you a nice red glow and it lasts for a while, but does it actually do something for your skin that’s permanent? No. So if you want to pamper yourself and look pretty and have a nice glow for a while, nothing wrong with it. But don’t expect too much out of it.
Q: What are some of the latest trends in dermatology?

  • A: Most of the cool new trends are in the realm of cosmetic dermatology because that’s the part of dermatology that has exploded in the last decade. So the trends are:
  • A whole new series of sunscreens on the market. The sunscreens in the past, like 10-15 years ago, were not very good. And so now we have very good sunscreens, which protect you from UVB and UVA light and they’re not too thick and greasy and quite effective.
  • The next thing that is also a very big trend is antioxidants. These antioxidants are important because they neutralize free radicals, which are the chemicals that are put on the skin from pollution and sun damage that actually lead to aging faster and they lead to increased risk of skin cancer. So if we want to neutralize these free radicals with antioxidants there are tons of companies out there that produce creams. The problem is you don’t know what to select and some of them are pretty much garbage. Personally, in my office, I carry a line called DCL and that particular line I’ve found to be very effective and it’s very nice on the skin. Using an antioxidant groups of creams (it comes in a kit actually called the anti-aging kit) in combination with the Vitamin C, which is another antioxidant, we’ve found that to be very helpful for treating skin and having an anti-aging affect.
  • Another trend is in the realm of makeup. Mineral makeup is where you have all of the preparations compounded without chemicals and preservatives that can have damaging effects on the skin. So these are minerals that are very inert, very natural. The particular line that we’re carrying in our office is called Colorescience.
  • In the realm of cosmetic dermatology the whole trend is towards non-surgical treatment. Everyone wants something to be done and avoid surgery and when we follow that route what we’re looking at is combination therapy, you’re not just going to come in for one treatment. We do a variety of things in combination because treatments can compliment each other. Doing Botox before a Thermage procedure makes a Thermage result even better. The number one cosmetic treatment in the world is still Botox.

Q: Celebrities are often ridiculed for being ‘over-Botoxed’. Can this be avoided?

A: They are. They may do it too often or the doctor many inject too much. The thing about any of these treatment is there are two parts to the physician treating the patient. There’s science and the art. Treating in medicine is really a two-pronged approach. You can have all the science and you can all the knowledge, you could be technically great, but if you don’t have that aesthetic, artistic eye when you look at the patient, you’re not going to do well. When you put a filler in, it has to look natural. That’s why people walk out when they have their lips done looking like idiots, they walk out with lips that look like they are swollen from an allergic reaction, it looks awful. What happens to the public is they get a false impression that if you get your lips done that’s what it’s going to look like, which is the furthest thing from the truth. If it’s done nicely, with an aesthetic eye, the results are great.

Q: How expensive is Botox?

A: Personally, I charged $14 a unit so that converts to $250 – $350 for an average frown area and if you’re doing a forehead in the range of $150-$220. Some patients will do multiple areas so they may walk out with a bill of $800 and it’s because they’re doing their forehead and their frowning area and their eyes. For men, generally the prices are higher because for men to do a frown area their muscles are bigger and they need a higher dose so you might go anywhere between $400-$600 for a frown area. Generally you’ll do it every four months. After you’ve been doing it for a while the patient will develop a better response and you can stretch out the treatments a little farther apart. Not for everybody, but most.

Q: What’s the age range that people start to come in to see you for anti-ageing procedures like Botox?

A: Even in early 20s. There are lots of people who start to get lines even in their early twenties because it’s simply a manifestation of their facial expression muscles. If they are very expressive or move their eyebrows up a lot, they’ll get their lines earlier. There’s a very interesting study where they took two twins and one twin did not have Botox and the other twin did have Botox starting from an early age and then they looked at these women when they were 45. The woman who had Botox on a regular basis had next to no lines. It is a very good preventative treatment. The sister who did not have Botox looked a lot older. So Botox if used very early on in the lines it will actually prevent them. It acts as a preventative treatment for lines.

Q: Are there any negative side-effects to Botox?

A: No. And that’s where the media really hasn’t done the public any favors if they want to be truthful to the public and give them good information. I don’t know why there’s this trend that the media love to paint a bad picture of Botox. And every time they’ve tried to do that, they’ve been proven wrong because it’s an extremely safe medication. It’s used in stroke victims, it’s used in children, it’s used in all kinds of medical indications, not only for cosmetic, and it’s used in those individuals in much higher dosages. We are giving cosmetic patients very small doses and there is no permanent, long-lasting side effects. It’s an excellent medication and I use it myself.

Q: What’s your personal skin routine?

A: I use Botox and I’ve been using it for quite a few years. I’m 53 and if you look at my face, I probably have a face that looks in the low-forties because I don’t have lines and it looks normal and natural. If it’s done the right way, it looks great. I just use a basic cleanser (Spectro Gel) I don’t use moisturizers that often. I don’t have a dry face. I do use lots of sunscreen, that’s the key. And now I’m going to start using the antioxidant line and Vitamin C.