To Be Young Again

Written on: Aug 18, 2019
By: Shari Hicks-Graham

Most of us prioritize health over beauty, but it is hard not to be curious about ways to maintain a youthful appearance. Recently, it seemed like everyone tried the FaceApp, which applied modifications to your portrait photos to look decades older. These images of our older-appearing selves are quite provocative for two reasons. First, it’s just fun to see changes the years may bring, and actually see a potential version of your older self. Second, this glimpse into the future could motivate you to consider whether or not you would be comfortable with these possible changes of aging. For some, this reckoning is reassuring, especially if you find the changes to be pleasant, or if you see similarities between yourself and a favorite older family member. Others may feel differently, not be happy with what they see, and find that they want to slow down the pace of these visible age-related changes. So, in this blog, I review some common dermatology related strategies used to help keep a youthful look.




Simply put, I believe in good skincare. There are a plethora of options including high-quality moisturizers, antioxidants, and peptides. However, for starters, consider using a retinoid over the counter or be prescribed a product like tretinoin or any of the vitamin A derivative products. They do a great job at fighting acne, blemishes and improving pore quality and diminishing wrinkles. Clinically proven, they are the superstars of skincare, but they do have some drawbacks. Dryness can be an issue with use, and they can also make the skin sensitive and cause peeling of the skin with waxing (beware to all my brow devas out there). The average cost of an over-the-counter retinoid is $20, prescription agents are at least $100 and up.  

Despite the recent controversy about sunscreen and their chemical components, I still wholeheartedly recommend using them. In my opinion, the benefits of sunscreen use and far outweigh their risks, and I also support the use of other safe sun practices (sunglasses, hats, etc) to round out the protection. I suggest wearing sunscreen that is well-formulated for your skin type (a lighter formula for oilier skin, a product formulated for sports if you are very active, etc), with at least spf 30 or higher. Physical sunscreens containing zinc oxide or titanium dioxide do not contain chemicals that get absorbed into the skin and work by reflecting the sun’s rays. This is great, but unfortunately, they are often opaque in color and don’t blend well on darker skin types. I also think that despite a recent well-written New York Times article by Kendra Pierre-Louis entitled “Should Black People Wear Sunscreen?”, I still feel that all of us, black folks included, need to use it for a variety of reasons, not the least of which is to help prevent photoaging and irregular skin tone. Stay tuned for more on this subject in a future post! The cost of sunscreen is on average $10 and up.  


One of the most famous cosmetic therapies are chemical peels. They have been documented to have been used in the early Egyptian period to help maintain beautiful skin. I enjoy them in the fall and winter to jump-start a skincare routine and improve clarity or fine lines. Many peels use glycolic, salicylic, lactic acid or trichloroacetic acid (TCA). In general, the lighter the skin, the more aggressive the peel type may be, and the darker the skin color, the more careful one must be in order to prevent untoward side effects like hyperpigmentation or scarring. It’s important to make sure that skin is in good health, intact and without any open sores or irritation prior to beginning a peel regimen. Another best practice is to have a chemical peel performed with a professional who is accustomed to using peels on your particular skin type and need. They should not be used on skin that is tanned or recently sunburned, or if you are planning to be in the sun shortly after the peel. A series of peels may be best, and appropriate topical skincare products should be used to ensure optimal results. Price of a typical mid-level peel may range from $150-300 depending on the skin issue and area of the country.  


Unwanted skin growths, or moles, are very common. Facial moles called dermatosis papulosa nigra (DPN) can create the look of an uneven skin tone, and skin tags are often irritating along the neckline. These unnecessary growths may be removed easily and safely on a cosmetic basis and will provide a major cosmetic benefit. It is important to see a board-certified dermatologist for guidance on the best way to accomplish the removal. Typically we use an electrodesiccation tool or laser for clean and efficient DPN removal, revealing clearer looking skin. Other moles may be removed surgically, depending on the type. The average price for a mole removal treatment session is $300 and up. 


There are several medications used for cosmetic purposes that are injected.  Generally speaking, there are line relaxers and fillers, along with a newer yet powerful option - an injectable lipolysis (fat melting) agent.   

The most famous line relaxer is Botox® (OnabotulinumtoxinA). At this point, Botox® is a household name and is often the joke of frozen faced comedians. It also may provoke a feeling of hesitation from those who don’t want to appear fake or unnatural. However, there is a reason why it is the most popular cosmetic treatment in the world. It simply works, is very consistent and is absolutely safe when injected properly. Other similar products on the market include Dysport® (abobotulinumtoxinA), Xeomin® (incobotulinumtoxinA) and newer Jeuveau® (prabotulinumtoxinA). These agents all work to relax the muscles that are treated to reduce wrinkles that come from dynamic movements like frowning. Botox® is approved for the lines in the upper face between the brows, and to smooth “crow’s feet” on the sides of the eyes, and on horizontal forehead lines. Nothing else works quite as well when lines are “etched in” from years of repetitive movement. My patients and I are also impressed by the improvement in skin quality and texture that we achieve from these products. Results typically last for 3-6 months and so the treatment must be repeated to maintain the results. Side effects are temporary but do include eyebrow heaviness, bruising, or transient swelling.  The average cost is $350-$500 depending on the amount of product used.      

Fillers (Juvederm®, Restylane®, Voluma®, among others) are injectable products that are used to revolumize the face. Historically, these agents are used around the mouth and nose to soften the folds, and in lips and cheeks to rebalance a sagging appearance.  They do an amazing job at providing a natural-looking improvement for jowls. Many of the newer agents are composed of hyaluronic acid, a substance found in the skin and joints, so allergy testing isn’t required. Filler agents are beautifully natural when applied correctly by physicians who are experienced in the craft. Results are seen immediately and may last up to two years. Side effects include bruising, nodule formation, or inadvertent injection into a vessel which could cause skin damage or blindness. Therefore, I recommend only having fillers injected in doctor’s offices who are expertly trained and board-certified in dermatology, plastic surgery, otolaryngology or ophthalmology. Cost of the service is typically $600 and up.  

There is one injectable agent, Kybella®, intended for use under the chin to permanently destroy fat. This product contours the profile and creates a more youthful appearance.  Typically it takes 2-3 treatments, and the sessions may be performed 6 weeks apart. Side effects include swelling, pain, numbness and bruising. I have been thrilled with the results that patients are able to achieve with this product. It’s certainly not right for everyone, but it is a treatment that can uplift confidence in a way that only liposuction or other surgical methods could achieve previously. Cost is approximately $1,000 per treatment.  


Dermatologists love tools and devices. We were early adopters of the use of lasers in medicine to help treat unwanted facial hair, uneven pigmentation, leg veins, facial redness and acne. The great news is that for the most part, we have lasers that can help many of the aforementioned conditions and are able to use an appropriate version of a laser device to help people of any skin color. In my practice, I love using a variety of lasers to treat patients’ specific issues in a tailored manner. There is not a one-size-fits-all approach, and for me, that’s the fun of it; and that’s how patients get their best result. Again, be choosy as you find the right provider as you consider your options for using light-based laser devices for cosmetic concerns.  Thankfully it happens less and less, we occasionally see patients who have developed scars from laser treatments gone wrong. Prices of all lasers and devices vary depending on the issue being treated.  

Treatments using energy for skin tightening, lipolysis (cryo - Coolsculpting® or thermal fat destruction - VanquishME®) and skin firming have also become popular for reducing belly fat. Microneedling, radiofrequency, ultrasound, and other minimally invasive modalities are fantastic because they provide amazing results on all skin types without the downtime of surgery, intense lasers or deep chemical peels. They can be used on face to smooth pores, diminish lines and wrinkles and firm the skin of the neck and arms. Stretch marks are also improved with these treatments. Recently, we have seen exciting and encouraging results in record time using a device called Secret RF, and there are other similar devices on the market as well.  


Although it may not seem fair or accurate, the cosmetic appearance of our hair can be highly influential in how old we look. Hair texture, length, and thickness are all characteristics that can, and often do, change with age. However, the natural greying of our hair tends to overshadow all other physical changes when people make assumptions about our age. As such, it is no surprise that hair dyes are extremely popular in helping people establish a more youthful appearance as well as to just keep styles fun and current. So, from a health care provider’s perspective, here’s what you should consider when using hair dyes. First, hair dye doesn't have to be organic or “all-natural” in order to be safe. Most hair dyes contain synthetic ingredients or chemicals but that does not make them unsafe or unhealthy for your hair or scalp. The key is to be aware of your allergies and skin sensitivities and avoid harsh chemicals such as ammonia, isopropyl alcohol, Quaternium-15, and p-Phenylenediamine (PPD) just to name a few.

  • Ammonia - used to lighten or remove hair color. It has an intense drying effect on hair and is also very harsh on the skin, commonly causing irritation to the scalp. Indeed, ammonia is known to produce a burning sensation if it comes in contact with the scalp. 
  • Isopropyl Alcohol - often has a severe drying effect on the hair and skin, which can cause irritation on the scalp. Don’t confuse this with Cetyl Alcohol or Cetearyl Alcohol, which have unique moisturizing properties.
  • Quaternium-15 - used as a preservative; it acts as a formaldehyde releaser, has relatively high toxicity levels, and is known as an allergen for humans
  • p-Phenylenediamine (PPD) - an organic compound that helps new color stay on your hair (darken) and although it has a low relative toxicity level, it is known to be a severe allergen. PPD is also known to cause skin irritations such as contact dermatitis among a few other adverse reactions.

Itching of the scalp caused by dandruff or other rashes can lead to hair thinning or hair loss, which may affect your appearance and negatively impact confidence. It is important to seek attention by a dermatologist who can help establish a solid diagnosis and care plan. I see these symptoms and hear complaints about dry, itchy, flaky scalp and hair loss a lot in my practice and developed the three LivSo products specifically to help people manage and prevent hair and scalp issues.

In summary, it’s critical to work with a physician who understands your dermatologic needs, appreciates your budget and time limitations. Fortunately, it’s a great time to consider your future appearance because there are a variety of options depending on your goals and appetite for change. So, are you willing to try the latest face-modifying app for a glimpse into your future? If you do, let us know how you feel about what you see. You may just be pleased and not want to change a thing!

Live free and clear,