Mature Skin Treatments At A Glance
- Best Results1-4 sessions
- Treatment RecoveryVariable
- Procedure Time15 to 90 min
- Skin SpecialistDavin & team
- Duration of ResultsVariable
- AnaestheticNumbing- sedation
- Back to WorkVariable
- Cost$-$$$$
Mature Skin
Time, coupled with the Queensland sun can accelerate skin aging. There are effective treatments to slow down, & reverse skin aging. The use of lasers, peels, collagen stimulating fillers, skin tightening devices & clinical skin care, can reduce aging by as much as two decades.
FactsFacts on Treating Mature Skin
- Collagen & fat start to decline in the third decade of life
- Skin has a one percent decrease of collagen annually
- Laser resurfacing can improve skin quality, reducing pigmentation & wrinkles
- Lasers can also reverse sun damage & pre-cancerous cells
- Skin tightening can be achieved with ultrasound & radiofrequency
- Volume can be addressed with dermal fillers & fat transfer
- A well-researched skin care routine can slow down skin aging
- Skin care can prolong the results you get from procedures
- The upper & mid layers of skin thin with age
Mature Skin
Balance is the keyword. Apply this principle to all ages, including mature skin. A simple 4 step plan is as follows-
Step 1. Improve skin quality. Lasers & chemical peels can improve skin texture, and reduce pigmentation, fine lines & wrinkles.
Step 2. Improve skin tone & turgor. This refers to skin tightening procedures including HIFU (High Intensity Focused Ultrasound), RF, as well as collagen stimulating fillers.
Step 3. Improve volume & support ligaments. This is achieved by strategic dermal fillers.
Step 4. Maintain results. Good skin care, coupled with low cost- low downtime clinical procedure including chemical peels & fractional lasers can slow down the ageing process.
What are ways to slow down the aging process?
Start with good skin care & lifestyle choices. Skin care includes sun protection, antioxidants & vitamins including ascorbic acid, retinol & niacinamide. Add skin acids to exfoliate every week. Preventive anti-aging procedures include-
Laser resurfacing. Simple fractional lasers for lighter skin types, and pico lasers for darker skin patients. We use one of 30 devices to help stimulate collagen, elastin & hyaluronic acid.
Chemical peels include retinoic acid & AHA peels. Peels can address sun damage, dull skin, pigmentation, enlarged pores, and congested skin.
Injectables such as dermal fillers & anti-wrinkle injections can reduce wrinkles & provide dermal hydration, whilst reducing volume loss.
The ideal combination of injectables, peels, lasers & skin care really depends on your age, skin’s clinical condition, ethnicity & aims. Book an obligation-free consultation with my nursing staff @cliniccutis to see what is best for your skin.
What about eye rejuvenation in mature patients?
Addressing skin quality, wrinkles & volume can make a huge difference in perceived age. Procedures include-
- Laser rejuvenation with CO2, erbium & fractional lasers
- Skin tightening with HIFU, RF, Thermage
- Anti-wrinkle injections to the crow’s feet
- Brow repositioning with dermal fillers
- Volume replacement of the orbital rim & tear troughs
A good skincare routine with ascorbic acid, retinol & pigment correctors can complement the gains from laser & injectable procedures.
Do duck lips look good in mature patients?
Duck lips don’t look good on any age group, however, disproportionately enhanced lips on mature patients are even worse! Perioral & lip rejuvenation in this age group is based upon supporting this region.
Dermal fillers are placed around the lip area, especially around the corners of the mouth. This allows for some lip eversion. Struts of filler in the upper lip area can reduce lip wrinkles & smoker’s lines.
View our Treatment Gallery
How do I treat smoker’s lines & upper lip lines?
The upper lip is one of the very first areas to age. There are a few options that reliably erase upper lip lines and wrinkles.
My favoured treatment for moderate to severe lines and wrinkles is that of laser resurfacing. Laser works by ‘erasing’ the lines and stimulating new collagen. Results are instant, but recovery times vary from 6 to 14 days, depending on depth of your wrinkles.
Deep chemical peels can be effective, in particular Jessner TCA or phenol croton oil peels.
Anti wrinkle injections & dermal filler can treat dynamic & static wrinkles with no downtime. This method is temporary and needs to be repeated every 3-8 months.
What type of lasers can be used for rejuvenation?
I use over 30 lasers & energy devices, however for mature skin, level 3 to 4 lasers are indicated. These lasers stimulate more collagen & provide much better wrinkle removal compared to level 1 & 2 lasers.
As a guide-
Level 1 / 2 concerns include mild sun damage, pigmentation, fine lines/wrinkles, mild scars & enlarged pores.
Lasers include: Clear & Brilliant, Fraxel, LaseMD, Fractional Pico, CORE CO2, HALO, IPL, Tixel (non laser).
Level 2 / 3 concerns include precancerous sun spots, deeper lines, heavy pigmentation, scars & textural changes.
Lasers include: Fraxel Dual, CO2 fractional CORE, Mixto, eCO2, erbium ProFractional, combination BBL/lasers.
Level 4 / 5 concerns include heavy sun damage, deep wrinkles, age spots & warts, deep scars.
Lasers include: Hybrid CO2 & erbium fully ablative / fractional laser resurfacing. Ultrapulse & Sciton lasers.
What is the best way to treat sun damage?
The standout treatment for sun damage is laser resurfacing. Lasers can address some forms of skin cancer, precancerous cells as well as other signs of sun exposure including pigmentation, dull skin & wrinkles. The type of laser resurfacing will depend on the extent of sun damage.
Fraxel HD is often combined with CO2 fractional for cases of mild to moderate sun damage, whilst ablative lasers such as the Ultrapulse is used to treat moderate to severe sun damage.
In some cases, I combine Photodynamic Therapy or PDT with lasers; most often in DVA patients.
How can you tighten skin?
The standout treatment for sun damage is laser resurfacing. Lasers can address some forms of skin cancer, precancerous cells as well as other signs of sun exposure including pigmentation, dull skin & wrinkles. The type of laser resurfacing will depend on the extent of sun damage.
Fraxel HD is often combined with CO2 fractional for cases of mild to moderate sun damage, whilst ablative lasers such as the Ultrapulse is used to treat moderate to severe sun damage.
In some cases, I combine Photodynamic Therapy or PDT with lasers; most often in DVA patients.
How can you tighten skin?
This is one aspect of skin rejuvenation you can not overlook, especially for mature skin. Put simply, skin tightening can be achieved surgically (face, neck, lid lifting) or non-surgically. If you have poor skin tone, a surgical approach is definitive.
Non-surgical skin tightening follows a highly complex algorithm. I take into account your skin quality, volume, laxity, dermal thickness, degree of elastosis (sun damage), ethnicity, age, & expectations. Options for skin tightening include-
HIFU; or High Intensity Focused Ultrasound treats the collagen in the dermis & the fibroseptal network. This device is best for thicker skin, with little sun damage.
Laser resurfacing; lasers can contract collagen. They provide a good ‘lift’ by tightening the dermis. This form of laser resurfacing is best for lighter skin types. Darker skin patients are best treated with RF or HIFU devices.
RF non-invasive: We currently use Tempsure or Pelleve as I have replaced the older Thermage system.
RF invasive: include FaceTite, often in combination with liposuction & Morpheus 8 or RFM devices.
Threads: include mono PDO, Silhouette & MINT suspension threads, often in combination with skin tightening devices. See the section on thread lifting.
Collagen stimulating fillers: I prefer the use of CaOH & PLLA collagen stimulating fillers in bespoke dilutions over HA fillers in the context of skin laxity. Most often I combine skin tightening devices post procedure to address.
Combination treatments: include threads, fillers, lasers & skin tightening devices.
What about chemical peels?
Chemical peels can be tailored to your skin goals. They can be used to correct or to maintain, depending on the depth of peel.
Superficial peels include glycolic, lactic, mandelic & retinoic acid peels. Downtime ranges from 1 to 2 hours for AHA peels, to 3-5 days for super strength retinoic acid peels. These peels are conducted by our dermal therapists & start at $98 AUD.
Medium to deep peels include TCA / Jessner TCA / Phenol Croton Oil peels. This form of chemical peeling is conducted under partial sedation by me. Downtime ranges from 8 days to 14. Deep peels are reserved for extensive sun damage, wrinkles & pigmentation. They give very similar results compared to ablative CO2 or erbium laser resurfacing.
As a guide, you should consider low downtime, low cost superficial peels to help maintain results following bigger laser procedures. One of my favourite peels is the retinoic acid peel.
Why dermal fillers?
As one matures, volume loss will accelerate. Aging depletes volume in the dermis, hypodermis (fat) & bone. There are only 2 ways to replace volume loss, either dermal fillers or fat transfer. I use both techniques, however favor the use of dermal fillers for reasons outlined below. Dermal fillers can be useful to treat –
- The midface area, highlighting cheekbones as well as providing a ‘liquid facelift.’
- The jaw line, prejowl sulcus & jowls. Strategic placement of fillers can cause traction & counter traction of this area, improving skin laxity.
- The perioral area & lips; fillers in this area can help provide support to the lips.
- Temples; frequently overlooked, but super important to address volume loss.
- The eye area including the orbital rim & tear troughs.
What is fat transfer?
Fat transfer can be used to replace volume & to improve skin quality (nanofat). In most cases I prefer dermal fillers over fat, however for patients who have severe atrophy – volume loss, fat transfer is an option.
This procedure involves harvesting fat from the flanks / abdominal area with liposuction. I then process the fat & re-inject autologous fat into the areas of volume loss. In the context of nanofat, & adipose stem cells, most patients will see some improvement of skin quality, however, this is not as predictable as simple laser or chemical peel procedures. Nevertheless it can be a useful adjunct.
Why should you use less muscle relaxants in mature skin?
I am not a heavy user of anti-wrinkle injections. I am more of a sprinkler than a big-unit injector. I do not like big units around the crow’s feet as I do believe the muscle around your eye holds up your cheek- most importantly as one matures. I don’t do big units in the frown, nor the forehead (unless you really have frown lines).
As the patient ages, you should adapt your technique of anti-wrinkle injections to reflect the change in movement. In mature patients I want a lift, rather than a drop. Injection of small units to the DAO can evert the corners of the lip. The chin can be injected to reduce the upward pull of mentalis.
In some patients, micro botox can be really helpful in reducing redness, enlarged pores as well as fine lines, and wrinkles. I combine neurotoxin with procedures such as TIxel or Aquagold to deliver muscle relaxants, hyaluronic acid & other skin care ‘actives’ into the dermis.
Can microneedling help?
In this age group (beyond mid 40s), microneedling has marginal effects, especially on established wrinkles & sun damage. Procedures that produce controlled healing will deliver better results, hence why I prefer RF microneedling for skin rejuvenation & tightening in mature patients.
Microneedling can be used to aid in delivery of skin care ‘active’ such as retinoic, ascorbic, ferulic acids into the deeper layers of skin.
What is a surgical lip lift?
The lip to nose ratio increases with age. This can elongate the philtrum, cause inversion of the upper lip & hide the upper teeth. A surgical lip lift can address all these issues, providing better ratios & proportions. In most cases I augment surgery with dermal fillers to provide support to this area. I also use ablative lasers to treat smoker’s lines during the surgical procedure.
Why does ethnicity play an important role in determining the best treatments?
The biology of skin differs across ethnicities. Skin directed treatments must address these differences as treatments are tiered towards your particular skin type. The algorithm is very complex as there are particular variations with both skin type, & individuals. A simplified way of thinking is as follows-
Lighter skin types: European / Caucasian skin are more prone to photodamage, sun damage, sunspots & rosacea. Less prone to some forms of pigmentation, dermal layer thinner with more broken collagen.
Darker skin types: Asian / Middle Eastern / Mediterranean skin. More prone to pigmentation, less prone to rosacea & sunspots. Thicker dermal layer with less broken collagen (elastosis).
*The above is just a broad generalization as there are always exceptions. For those individuals who have taken good care of their skin, photodamage will be much less.
How does skin change with age?
Skin changes are frequently seen in the early 40s. Mature skin has several key issues-
- Your skin may be more sensitive than before. Menopause may lead to flushing, blushing, & redness. Rosacea is a frequent manifestation of mature skin. The skin should be tailored accordingly.
- Pigmentation may be more pronounced, both hormone related & sun related. Mandibular melasma is more common in mature skin, additionally late onset melasma is more commonly associated with ethnic skin types.
- Xerosis or dryness increase with age, hence more occlusive skin care may be required, especially in drier, less humid climates. Think hyaluronic acid, tocopherol, niacinamide, & shea butter as key ingredients.
- Skin thins with age, this includes the fat, dermal & epidermal layers. Skin care should reflect this change & address these issues.
What skin care ingredients & products should you consider?
Choosing the right skin care ingredients can be tricky, especially in mature skin. We need to consider many factors including your skin type, sensitivities, as well as specific skin goals including anti-aging, anti-pigment, & anti-redness. The algorithm is really complex as we also need to take into account your current skin care routine.
Read more on how to incorporate antioxidants, niacinamide, retinols, & skin care acids as part of your skin care routine.
Why antioxidants?
Antioxidants are the second layer of defence after sunscreens. These molecules protect your collagen & DNA from free radical damage due to UV radiation & environmental pollutants. Look for the following ingredients-
- Vitamin C or ascorbic acid is one of the most powerful antioxidants. This is why most dermatologists will advocate its use in the AM, under SPF. The activity depends on the formulation pH. You should aim for a pH range of 2.5 to 3.5 for maximal penetration into the deeper epidermis. I suggest starting at 10% for mature skin types as sensitivity is often an issue. Don’t use if you have rosacea as this will often flare this condition up.
- Vitamin E or alpha tocopherol is a fat-soluble vitamin & often incorporated with ferulic acid & ascorbic acid. It has a low irritation potential.
- Vitamin B or niacinamide is a good choice for rosacea/sensitive skin. This has antioxidant as well as anti-inflammatory properties.
- Ferulic Acid is a naturally occurring antioxidant found in cereals like oats. It stabilizes vitamin C & E, and hence has synergistic effects with these skin vitamins. The best formulations will have CE & Ferulic mixed in.
- Resveratrol is a naturally sourced antioxidant from red wine. Green tea, isoflavones, soy, ginseng, & botanical berries: all excellent naturally occurring antioxidants found in organic skin care products.
What are the fundamental skin care ingredients you should look for?
Start off with a strong foundation of vitamins A, B & C. Retinol is a form of vitamin A. This gets converted into the active form called retinoic acid. A more powerful form of vitamin A is called retinaldehyde. This requires only one conversion step before becoming retinoic acid. Retinol Esters are weaker, and hence why they are used in patients with sensitive skin.
The major drawback of retinol & retinoids is their potential to cause skin irritation. As a guide, most experts will advocate a lower strength retinol to start with, thereby increasing the concentration over a period of time- usually 3- 6 months. Start off with good formulations of say, 0.5 % retinol, increasing to 1.0% over 3-6 months. Medik 8, Obaji, The Formulated, & Aspect Dr make great formulations. If you have sensitive skin, Murad Retinol *Youth Renewal is my pick.
Niacinamide or vitamin B3 is an important skin vitamin. This is my go-to ingredient (in the context of anti-aging) if you have sensitive skin. Niacinamide can be used twice a day, starting off with a good formulation of around 10%. B3 goes well with retinol because it can potentially reduce retinoid induced skin irritation.
Vitamin C or ascorbic acid is a useful skincare ingredient if your skin can tolerate it.
Most formulations are between 10 to 20% L ascorbic acid. Vitamin C is a very unstable molecule, and hence requires special requirements in the formulation. This means the best bioavailability & stability is in an acidic environment, pH of 2.5 to 3.5. What this means clinically is that if you have sensitive skin, it may cause skin irritation.
This especially applies if you have rosacea (common in more mature skin). Good formulations with a concentration of around 10% can reduce irritation. These include Obagi, Aspect Dr, Medik 8, The Formulated & Skinceuticals.
What DIY or home treatments can you implement?
As discussed, a simple, yet scientific approach to skin care will yield the best results. There are however some DIY procedures that may improve your skin. They include-
- Microcurrent devices. There are many on the market. These devices can provide some benefit in improving skin tone (tightness). The best results are seen in patients with little or no photodamage with a thicker dermal layer. Objective clinical results are difficult to interpret, however the subjective feeling of tighter skin is often a consistent finding. I use microcurrent myself as part of my DIY rejuvenation routine.
- Microneedling devices can be effective for treating mild textural changes including enlarged pores & fine lines. In the context of mature skin, they are best served to aid in dermal drug delivery. A safe home use needle length is between 0.2 to 0.3 mm. At this length, roller, stamping or pen like devices are much the same.
- Home LED or Low Level Laser emission devices: these devices are not as good as microcurrent. Outputs are too low. They can be useful as adjunctive treatment for acne prone skin.
- Chemical peels are great if you know what you are doing. In the context of safety, TCA peels can be used in caution – 10% maximum with 2 coats. Buffered AHA peels including glycolic or lactic acid can be considered. 10-30% solution. Don’t burn yourself. I really think chemical peels at moderate to high strength should be supervised or conducted by a skin care professional.
When should you consider surgical intervention?
The truth is that non-surgical interventions can only go so far. A simple way to approach things is-
Surgery is definitive for lifting. This includes the neck, face & eyes. Surgery improves skin tone but does not address skin quality nor volume. If you have volume deficits, dermal fillers or fat transplants are required. If skin quality needs to be improved, lasers & peels are indicated.
If you have excess volume (fat), liposuction & skin tightening could be the ideal combination.
What are the treatment costs?
Costs vary with what procedure & who performs it. As a guide, I perform complex procedures including surgical, deep peels, super deep lasers, complex injectables, liposuction & other invasive procedures. My talented nurses perform injectables, & lasers (level one to four).
Injectables:
- Dermal filler $1290 (Davin), $600-$790 (nurses).
- Muscle relaxants $20 per unit (Davin), $12 (nurses).
Laser Resurfacing:
- Level 1 Resurfacing – $420 to $590 eg. Clear & Brilliant
- Level 2 Resurfacing $990 eg. Fraxel
- Level 3 Resurfacing $1,290 eg. Fraxel High Density
- Level 4 Resurfacing $1,990 eg. Fraxel + CO2 Fractional
- Level 5 Resurfacing $3,990 – $6990 eg. CO2 +/- Erbium fully ablative laser resurfacing
Skin tightening
- Tempsure – Pelleve From $780
- RFM Genius From $890
- FaceTite From $4990 (Davin)
- Ultherapy/HIFU From $990
Book for assessment with my clinical team for an accurate quote.
Threads
- Monofilament, Silhouette & MINT POA
Surgical & Liposuction
- Blepharoplasty, neck liposuction, mini-S-face lifts: POA
Davin’s Viewpoint, treating mature skin
Treatment of mature skin requires the skill sets of lasers, peels, dermal filling (& injectables) as well surgery. Contrary to Google Ads targeting Brisbane, a laser dermatologist is not the optimal way to address skin quality, tone & volume changes.
Let’s break things down for a logical step by step & analytical approach to skin aging.
Firstly addressing skin quality. This includes sun damage, pre-cancer spots, wrinkles, & pigmentation. This is where lasers are useful. There is a specific laser wavelength for every condition & skin colour. Within the same wavelength, there are many different ways to deliver the energy. Variables such as spot size, pulse width, pulse distance, pulse duration, power & technique can deliver vast outcomes. The two most common fractional lasers used by myself & my nursing team are the 1927 thulium lasers (Fraxel, LaseMD) & CO2 lasers. These lasers can address skin quality. The majority of patients in the 30s to 50s will benefit from fractional devices without the requirement to go fully ablative.
For epic wrinkles & sun damage, the use of fully ablative lasers are useful. My go to CO2 laser is the Ultrapulse. This method of skin rejuvenation gives spectacular results, albeit a downtime of 7 to 14 days.
Skin laxity can be treated on the same day with skin tightening devices. Tightening can be achieved via HIFU or microfocused ultrasound, using devices such as Ultherapy or RF devices such as Thermage, Tempsure, Pelleve or FaceTite. Volume replacement is important to address. We lose 1% of collagen annually from age 25. True fact. With age, the supporting ligaments & fibroseptal network weakens, this coupled with fat & collagen loss means deflation & downward movement of fat pads. This is why dermal fillers are an essential element of skin rejuvenation. I employ both collagen stimulation fillers as well as traditional hyaluronic acid fillers. Fat grafting can also be useful in patients who are severely volume depleted. The downside about fat grafting is the unpredictability of the end result as there are highly variable absorption rates.