Treating the 60-plus cosmetic patient

Dermatologists need to recognize those needs and anticipate pitfalls associated with older skin in order to best help elderly patients with their quests to look younger and refreshed.

Environmental damage ongoing

"Often, patients over 60 will say to me that the damage has been done. That is the wrong way of looking at it, because the damage continues every day that we get sun," Dr. Gordon says. "When a patient comes in to see me, the first thing we talk about is great sun protection - not just a high SPF sunscreen, but also full spectrum, including UVA and UVB and other sun protection techniques."

Dr. Gordon makes it a point to review a moisturizing skincare regimen with her age 60-plus patients. She emphasizes not so much the active ingredients but rather the formulation of products.

"It comes down to finding a formulation that is the right mix for an individual and sometimes this means trial and error," Dr. Gordon says.

Staying on the same page

The consultation with the patient should be realistic and touch on what is age appropriate, says Heidi Waldorf, M.D., associate clinical professor at Mount Sinai Medical School, New York, and the director of laser and cosmetic dermatology at Mount Sinai.

"At least in my practice, most 60-year-olds do not want to walk out with 20-year-old lips," Dr. Waldorf says. "Either they need realistic expectations - or you do - about what looks appropriate. So you need to plan your cosmetic treatments appropriately for the patient's expectations," Dr. Waldorf says.

Dr. Gordon says, generally, the goal should be to soften wrinkles as much as possible and shave maybe a decade from one's appearance.

"If we are shooting for something too extreme, we are not going to have a very natural look, and my goal is to make people look naturally great for their age," Dr. Gordon says.

Older generations of patients lose subcutaneous tissue. Sunken cheeks and deep crevices around the mouth are telltale signs.

Dr. Gordon addresses the loss of volume and deep wrinkling with fillers. She uses a layered approach, with a robust filler to address deep recontouring and a fine-line material filler to smooth the etched lines on the surface.

Tread lightly, advance cautiously

Where using peels on older patients is concerned, Dr. Gordon says that dermatologists should keep in mind that skin cell turnover rate slows with age.

Very often, older patients have a dull, dry look to their skin; so, they can benefit from exfoliating.

"On the other hand, the blood supply to their skin and healing might not be as good as when they were younger. Until I learn a particular patient's skin inside and out, I go gingerly. I always start with a light peel or a gentle at-home exfoliating program where we build up slowly to see what they can tolerate," Dr. Gordon says.

Dr. Gordon addresses brown spots first with less aggressive peels and bleaching creams. If those do not work, she might refer a patient for laser treatment.