Combination techniques for the face

New Orleans - Dermatologists rarely use any facial rejuvenation procedure in a vacuum.

"We have so many technologies; so, we combine things," Dr. Farris says.

The combinations might include topical treatments, peels, fillers and technology.

Dermatologists tend to combine minor procedures to achieve results that are close to those of ablative procedures. In reality you won't be able to mimic the results from procedures such as dermabrasion and CO₂ laser resurfacing, Dr. Farris says, but by combining the technologies currently available you can get close.

"People are more interested in getting improvement without downtime," she tells Dermatology Times.

Dr. Farris prescribes retinoids or recommends a cosmeceutical for just about everyone who has an anti-aging consultation.

"Topical treatments are a standard part of all of our anti-aging regimens," she says. "Then, we add procedures based on what we see in the aging face."

For patients who have a lot of discoloration and telangiectasia, Dr. Farris will usually use intense pulsed light (IPL). She says patients who have sun-induced discoloration or erythema are good candidates for the technology.

"We use it on anyone who has a lot of visibly photodamaged skin, with lentigos, actinic keratoses, telangiectasias, sun-induced erythema or poikiloderma of Civatte. It rejuvenates the skin in a way that we really cannot otherwise achieve because it so nicely targets brown spots and telangiectasia," Dr. Farris says.

"For patients with more severe actinic damage, we may use photodynamic therapy (PDT). There is more downtime and potential problems using it, but the results can be dramatic."

Filling lines - and between them

The dermatologist turns to fillers to address patients' deep nasolabial and melolabial folds.

She prefers the hyaluronic acids. If a patient has loss of facial volume, she might use Sculptra (Dermik). Sculptra is for a specific kind of patient: One who has a lot of lost volume and is looking to improve contour - not necessarily fill up facial lines and wrinkles, according to Dr. Farris. She says that while Sculptra improves contour by filling in volume and lifting the skin, she prefers Restylane (Medicis) over Sculptra for addressing deep facial crevasses and lines because it is less expensive and less time-consuming for the physician and the patient than is Sculptra.

"If a patient has obvious forehead lines, wrinkles or extensive crow's feet, I will add Botox (Allergan)," she says. "We can get improvement with Botox in the upper face - almost like a patient who would have had a forehead lift. It is amazing how dramatic it is."

Dr. Farris usually does not combine IPL with fillers and Botox in one appointment. While she usually will do fillers and Botox on the same day, Dr. Farris says she will schedule a separate appointment for lasers or IPL because of a patient's ability to tolerate multiple procedures. Lasers and light sources tend to be slightly more painful and can be time-consuming in the office.

"People do not want to spend three hours here," she says.

Peels and more

Dr. Farris also uses chemical peels in combination with other facial anti-aging procedures.