The Plastic Surgeon

Dr. Sherrell Aston debunks a common misconception about face lifts, and reveals his favorite techniques for smoothing wrinkles.

“The skin is like a corduroy jacket,” says New York Dr. Sherrell Aston, perhaps one of the world’s most famous plastic surgeons. “Shortening a sleeve of the jacket is like a face lift—it takes out the extra slack, but it doesn’t smooth the corduroy’s ridges.” As Dr. Aston explains, it takes more than a face lift to turn corduroy into silk. “A face lift is not for wrinkles,” he says. “It’s for correcting sagging tissue.” To treat wrinkles, Aston takes a dramatically different tack:

“The most effective treatment for deep wrinkles is a phenol acid-based peel. This invasive chemical peel sloughs off the top layers of wrinkled skin, which causes cell regeneration. Anesthesia is needed for a full-face peel. A peel done just around the eyes or mouth doesn’t require any sedation, as any burning lasts only about 20 seconds. But your skin will not look smooth and fresh immediately. For up to two weeks after the procedure, you’ll look as if you have a very severe sunburn, and some redness will remain for up to four weeks. A mild painkiller, such as Tylenol or Advil, is recommended. After 10 days, makeup can be applied to tone this down. Unfortunately, side effects can include a permanent lightening of the skin due to pigment loss and, in some cases, scarring—make sure you go to a licensed and experienced physician for this treatment. But no matter the modality of treatment (peel, laser, or dermabrasion) you choose, you run the risk of lightening the skin if the treatment reaches the depth of the pigment cells (all pigment cells are in one layer of skin). I have had great success with phenol peels.

“Laser resurfacing, which uses a laser to literally burn off layers of skin, is the “hot” treatment right now. The type of laser used depends on the severity of the wrinkles, but anesthesia is always needed. A carbon dioxide laser is the most intense, requiring a longer recovery and a 12-day waiting period before applying makeup. An erbium laser removes more superficial layers of skin, allowing for a quicker recovery. Still, makeup should not be applied for at least eight days after the procedure.

“Dermabrasion is the least popular of the treatments I use, yet the results are quite good. Either a high speed wire brush or a diamond burr is used to sand the skin to lessen deep wrinkles. Makeup should not be applied for 10 days to two weeks, and anesthesia is needed during this treatment.

The Plastic Surgeon

“Trichloroacidic acid peels are great for fine lines and lesser wrinkles. The treatment does not go as deep as a phenol acid-based peel, so skin redness is not as severe and does not last nearly as long. Makeup can be applied after a few days.

“Glycolic acid peels can be done on your lunch break. You’ll go back to work with glowing—not red—skin. Glycolic peels, also called fruit acid peels, are very gentle and only remove the most superficial layers of your skin.”

General tips:

“Concentrate on improving wrinkles, not eliminating them. If you go too deep when sanding the ridges of a corduroy jacket, the fabric will look worn. The same is true of your skin. Rely on the clinical judgment of your physician to determine which treatments are best for your skin type and quality (elasticity and collagen content).

“After any treatment, it’s absolutely necessary to avoid the sun, which destroys collagen fibers and permanently alters the skin’s elastin. Wear sunscreen that contains both UVA and UVB protection, to protect your skin and to prolong the results of your chosen treatment.

“Exfoliate regularly to remove the superficial layers of your skin. Any vitamin A-based cream, such as Retin-A or Retinol, or a cream with glycolic acid will encourage cell turnover for fresher looking skin. These are great overnight treatments. (see Exfoliation story)

“Don’t smoke cigarettes. Nicotine reduces the flow of oxygen in the blood and causes premature aging of the skin. And pursing the upper lip (when inhaling) causes more wrinkles.”