Dr. Howard Sobel, MD, is a Board Certified Cosmetic Dermatologic Surgeon and the first editor-in-chief of the International Journal of Cosmetic Surgery and Aesthetic Dermatology. He is recognized by both New York Magazine and the Castle Connolly Guide on How To Find the Best Doctors in the New York, Metropolitan Area as one of New York's premier cosmetic dermatologic surgeons for eleven consecutive years.
A dermatologist to the stars reveals the non-invasive treatments that really work.
Posted on August 31, 2011
Meet Dr. Howard Sobel at the Beauty Bash, Oct. 1-2 in New York City.
“Most women in their 50s do not need a facelift.”
So says cosmetic dermatologist Howard Sobel, a New York MD who’s gained a cult following among women who want to look tighter and smoother, without going under the knife. One conversation with Sobel and it’s clear that this is a man who’s passionate about his job. If you’ve ever witnessed a football fan discussing his Fantasy team, you get a sense of what Dr. Sobel sounds like when he talks about laser treatments. Here, he discusses the latest non-invasive treatments that “really work.”
FOF: When it comes to their faces, many FOFs are particularly interested in non-invasive anti-aging treatments--creams, lasers, facials and so on. Which ones work the best?
Dr. Sobel: I know we’ve all heard this, but the very best anti-aging regimen starts with prevention. Stay out of the sun and use a sunscreen properly. That means putting a full teaspoon on your face every day and re-applying every 2-3 hours if you’re outside. SPF 30 is probably enough (there’s not a big difference in protection when it goes above 30).
Is there a specific brand that you recommend in your own practice?
Well, we created our own line, DDF, which is now owned by P&G. It’s good, but there are a lot of good sunscreens on the market. Just make sure it blocks UVA and UVB rays.
Okay, so what about the woman for whom the damage is done. Now what?
Right, so once you have that sun damage, you’re naturally going to lose elasticity in your skin. You get fine lines, wrinkles, and hyperpigmented areas where skin becomes irregular, rough and lumpy. There are amazing lasers for that.
Let’s start with the least involved! Are there any creams that work?
There are some topicals that will get rid of the uneven pigmentation--somewhat. The key ingredient is hydroquinone. Some people are a little afraid of hydroquinone because there were studies connecting it to cancer in mice. But we know now that hydroquinone is very safe and there’s nothing wrong with using it. The trouble is, it doesn’t always work.
Tell me about the lasers.
The one I like is the Fraxel Dual laser--1927 wavelength. It really removes the sun damage...brown spots, uneven skin, etc. It’s terrific. You’ll need one or two treatments, depending on how much sun damage you have, and there’s no downtime. You might get what looks like a little cat scratch right afterward--you can cover it with makeup.
How much does that cost and how long does it last?
Not costly by laser treatment standards. It’s $1500 per treatment, and the results last as long as it takes for you to re-damage you skin through sun exposure. Also, it’s a laser that really works. There are a lot of lasers out there that promise to do everything--and do nothing.
Does that also get rid of wrinkles and sagging?
Yes, you can set that same laser to a different wavelength, and it removes wrinkles and fine lines and tightens the skin. I think it’s most effective to get rid of the pigmentation first and then have the patient come back in two or three months to have the wrinkles done. Some doctors will put the laser up to half strength and do a little of each, but I find that doesn’t work as well.
Another great laser for skin tightening is the eMax. It actually goes below the skin and tightens the collagen fibers and stimulates the collagen. It gives the skin back its elasticity.
What are other laser procedures really work?
The ulthera laser--it’s actually ultrasound, not a laser--tightens skin and stimulates the fibroblasts to make collagen.
And the C02 laser works well to get rid of fine lines and wrinkles. C02 lasers used to have several weeks of recovery time, but now we have C02 lasers called fractional C02s which have very little downtime--they’re excellent.
You’re known for doing “facelifts” with injectibles. Can you tell me about that?
It used to be that if you had a little loose skin, and you wanted to look younger, plastic surgeons were very keen on doing facelifts--earlier than later. But now most people believe that volume creates a younger face. A surgical facelift causes the skin to get pulled, and if you don’t put volume back, you look like you got caught in a wind tunnel. So you don’t have loose skin anymore, but you don’t necessarily look better--you just look like someone who had surgery. Injectables like Juvederm, Radiesse, etc, create volume.
I know that injectables can fill in wrinkles, but if you have sagging skin and jowls, do they really help?
Yes, they absolutely lift. For example, I’ll inject filler on top of your cheekbone, and that creates volume that actually lifts the skin on your cheek. It’s like re-draping a shirt on a hanger. I do a very popular procedure called “The Trifecta” which involves three types of injectables--Botox, Radiesse and hyaluronic acid. The results are comparable to a facelift. Wrinkles and lines are smoothed and sagging skin is actually lifted and tightened.
What is the Botox for? That’s not really a filler, right?
Nothing works better to get rid of dynamic lines than Botox. Your crows feet, your worry lines, the wrinkles on your chin. No matter how much filler I use on those, they’ll keep coming back because you’ll keep creasing the skin. Botox actually stops the muscle from moving so the creasing stops. Unfortunately, you have to do it every 3 or 4 or 5 months, but, like I said, nothing works better.
So who is a good candidate for "The Trifecta"--or any “injectables” lift?
That’s for someone who wants to look younger and fresher, but doesn’t want surgery. Patients literally can walk out and look ten years younger.
What are the limitations of these non-surgical procedures? In other words, when do you refer a patient to a plastic surgeon?
Between the lasers and injectables there’s so much you can do. And I think the biggest mistake you can make is doing too much. But once you get into your 60s and the skin around the neck area starts to hang, you probably will need the knife to get rid of it. Filler won’t be enough. But just cutting, without filler, isn’t enough either. Because these days, the trend is to do a lift and then still add volume back in.
What is the biggest mistake women over 50 make when it comes to their faces?
Of course, spending too much time in the sun. The other thing is, women come in and have cutting and pulling procedures a little earlier than they needed to. They wind up with their eyes up near their scalp. Too much surgery is much worse than no surgery at all. Start with the simplest procedures and work your way up.
What non-invasive procedures on the horizon are you most excited about?
Injections and topicals that can actually turn on individual cells to increase collagen production and give us back our youth. Or that can inhibit the enzymes that stop collagen production. There are are topicals now with stem cells and dermal growth factors but they don’t work yet. They just don’t penetrate the skin. And this is something you have to be careful with, because any factor that encourages cell growth might encourage a cancerous cell to grow--like a melanoma. I don’t know when it will be ready, but that’s the future.