Secrets to Firm, Glowing, Youthful Skin

Many people, as they get older, try to find just the right balance between aging naturally and making the most of their looks. Most don’t wish to completely erase the signs of aging — their goal is to preserve and maximize their assets.
 
According to a 2007 study, 44 million baby boomers spent more than $4 billion on “anti-aging products” in the previous 12-month period. Of those surveyed, 68 percent said it’s important for them to look good. The American Society of Plastic Surgeons reported that in 2012 there were more than 14 million cosmetic procedures performed in the United States alone. That's an increase of 5 percent over the previous year.
 
These days there are many safe, accessible ways to look younger with just a little enhancement, from lifts to injectables to products that actually preserve the skin. 
 
How Skin Changes With Age
 
Unfortunately but inevitably, certain changes occur with age. Gravity pulls and we lose fat in our face. The epidermis, or outer skin layer, begins to thin and the number of pigment cells diminishes. In a process called elastosis, the skin’s connective tissue degenerates, which takes away its elasticity. Blood vessels weaken, causing the skin to bruise more easily. And with age come wrinkles, creases, age spots, fleshy chins and jowls and droopy eyelids. 
 
Everyone’s skin ages differently due to genetics, bone structure and how they’ve taken care of themselves over the years (or not taken care, by smoking or getting too much sun or eating a poor diet). But it is possible to minimize some of the telltale signs of aging. “There really is such a thing as anti-aging,” says Dr. Debra Jaliman, author of Skin Rules: Trade Secrets From a Top New York Dermatologist. A world of products and procedures bears testament to that.
 
(MORE: Can Sunscreen Keep Your Skin From Aging?) 
 
Extreme Makeover: Facelifts
 
Benefits: A full lift will smooth the face and neck, restore a youthful contour, remove excess skin and firm up underlying muscles and tissue. This procedure, performed under general anesthesia, involves cutting and lifting sagging skin, rearranging and tightening the muscles underneath. Incisions are made in front of and behind the ears and can run up the hairline.
 
Today there are a number of modified, or “mini,” facelifts, which are less expensive and have a quicker recovery time. The mini-lift does not cut through as many deep tissue layers and is focused on a limited area of the face, mostly the lower half, including the naso-labial folds between the outer edges of the mouth and the nose (and, if desired, the upper neck). The skin is lifted and repositioned and facial tissue is removed, but incisions are not as large as full-fledged facelifts. Typically, only a local anesthetic is needed.
 
One of the newest procedures is the nonsurgical Stem-Cell Lift. It’s done under local anesthesia, the results look more natural and risks and drawbacks are minimized.
 
In this procedure, fat is harvested from the stomach, buttocks or thighs, and the stem cells within the tissue are separated in a centrifuge, then injected into the face. According to the doctor who developed the technique, stem cells regenerate tissue, sculpt the face and have a more permanent effect.
 
Downside: Traditional facelifts require general anesthesia, which comes with its own set of risks, and the insertion of drains, which stay put throughout the two-week recovery process. During that time, you’re bruised, swollen, uncomfortable and have blurred vision. Costs start around $10,000 and run upwards of $25,000 with anesthesiology fees. Mini-lifts cost between $5,000 and $9,000. And the results aren't permanent. They will last several to many years, depending on your bone structure, skin and care.
 
Injectables
 
Benefits: Botox and crease fillers reduce wrinkles, smooth lines and plump skin without surgery for a fraction of the cost of a facelift.
 
Botox, a purified form of the botulinum toxin, and the newer generation of muscle paralyzers like Dysport, work by paralyzing the muscles that cause wrinkles. These are used on the upper half of the face, most commonly the crow’s feet on the outside of the eyes, the forehead and the bridge of the nose. Results appear in five to seven days and last anywhere from four to six months. The cost ranges from $200 to $500 per area.
 
(MORE: Can Botox Beat Depression?)

The most popular crease fillers, Restylane, Juvéderm and Radiesse, are composed of hyaluronic acid, collagen or calcium hydroxyl apatite and used on the lower face. They’re effective at smoothing out wrinkles, filling in the naso-labial lines, camouflaging jowls, removing creases in the chin, fleshing out cheeks and plumping lips. The newest product is Belotero, which Jaliman uses for lip lines and crow’s feet. “This filler was specially designed to morph into an individual’s specific facial contours and looks more natural than the others,” she says.
 
Fillers last from six or seven months to a year depending on your skin. Results are immediate, and the only "down time" is letting possible bruises heal . Because the molecules of the fillers are different sizes, some are better for deep grooves and others for superficial ones. Most people need several syringes to achieve the desired effect at once, and they run between between $450 and $750 each. 
 
Downside: The face can easily bruise at the spot where the needles are injected. Sharper needles are less painful but cause more bruising.
 
Lasers
 
Benefits: This pioneering treatment is highly effective at reviving discolored and dead skin and stimulating the regrowth of healthy skin. Lasers cause tiny microscopic tears inside the skin, which triggers the body to produce more collagen. 
 
Different types of lasers are used on the neck, chin, jowls and brows and around the eyes. Cool lasers, emitting lower levels of light, do not create thermal changes in the tissue but do incite healthy skin to grow. High-powered lasers use heat to destroy tissue and damage the outer layer of the skin (new skin will naturally grow back).
 
The latest development in lasers is called Ultherapy. Doctors who use it, like Dr. Erin Gilbert, a board-certified dermatologist in Brooklyn, N.Y., say it's ideal for patients who don’t want a facelift but would benefit from skin lifting. 
 
Ultherapy uses a more focused ultrasound technology to stimulate collagen production over time. It targets the muscle and deep connective tissue and can tighten jawlines, smooth necks and raise drooping eyebrows in patients with moderately sagging skin. Results usually require multiple sessions and typically last about 10 years.
 
Downside: Mild swelling and redness occur, but subside within a day. Some patients report bruising. Doctors recommend four to six treatments (about a month apart), so changes are usually gradual. And it’s not cheap: Treatments cost in the neighborhood of $1,300 a session. 
 
Peels and Products
 
Benefits: When acidic chemicals are applied to the face, they strip the outer layer of skin, exfoliate and tighten it and stimulate collagen production. In the process, age spots, wrinkles and fine lines get erased; a new layer of healthy skin develops and as it continues to grow, the skin’s texture improves. 

(MORE: How to Read Anti-Aging Cosmetics Labels)
 
Peels contain varying concentrations of acids and chemical components and are classified as superficial, medium or deep. Superficial peels are the most gentle and can be used on all skin types. The most noninvasive peels contain mild ingredients, like glycolic acid. The deepest peel, which contains phenol and can only be administered once because of its intensity, penetrates multiple skin layers and in effect gives the skin second-degree burns.
 
Many peels contain exfoliating alpha hydroxy acids, but they vary in concentration. The strongest chemical peels have AHA concentrations of 50 to 70 percent. But a plethora of moisturizers and cleansers with AHA is available over the counter — these have a concentration of less than 10 percent and aren’t quite as effective.
 
Natural ingredients can help brighten the skin, including vitamin C, lactic acid, kojic acid, white willow bark and certain grape vine extracts in pill form. Dr. Gilbert notes that antioxidants like pomegranate, vitamin C and green tea help even out skin tone and make it glow. 
 
Downside: For a serious peel, the recovery time can be as long as 12 days, during which the skin is very swollen and bright red. Costs range from $150 for a light peel to upwards of $5,000 for the deepest ones. 
 
Whichever route you go, you'll benefit from taking good care of your skin, keeping it clean, applying moisturizer and sunscreen daily, maintaining a good diet, exercising and getting plenty of restful sleep. If you do opt for a procedure or two, research it — and the doctor — online. Better yet, get a referral from someone who had the same work done, reported a great experience and looks good. In either case, be sure to schedule an in-person consultation first, and come prepared with a list of questions and concerns.
 
Jeryl Brunner is a journalist and the author of two books: My City, My New York: Famous New Yorkers Share Their Favorite Places and My City, My Los Angeles.