We have built a successful facial rejuvenation program over the years and have helped thousands of our patients feel better and look as young as they feel. My treatment approach has always been based on the fact that our faces age by changes in:

  • Volume. Loss of facial fat leading to loss of facial volume results in a tired, deflated look.
  • Sagging. Excess soft tissue around the eyes, jawline, and neck results in a change in facial shape.
  • Skin. Loss of skin elasticity, collagen, and pigments result in fine lines and wrinkles, and discoloration.
Carmel Valley Plastic Surgery

The Three Pronged Approach

In order to achieve a natural, balanced and harmonious outcome we must evaluate and address these changes. This three-prong approach has served our patients well over the years and is what gives our results that highly sought after, naturally refreshed look.

However, like many of you, I have been feeling confused by all the choices out there for skin care. All you have to do is take a walk through a department store, drug store, or Sephora, and you are left with your head spinning. So many pretty bottles filled with lotions and potions that smell and feel great, but what exactly are they doing for our skin (if anything)? Most of you most likely have no idea what is actually in these products and what they are doing.

Feeling somewhat overwhelmed, I have been hesitant to try and crack the code and decipher what really works and what makes sense. However, I felt I owed this to my many patients who have been wanting to actively slow down the skin aging process or protect their investment following our procedures. After all, the skin is truly the only part of facial aging that we can actually slow down by what we do at home or in the office. Volume loss and sagging just happen and we treat them as they come.

I am glad to report that I have reached conclusions that I am comfortable with and confident recommending to all of you. The approach is based on clinical and laboratory studies as well as actual results. It is based on medical grade products that have science to back up their use.

So let's examine why everyone can benefit from a good skin care program and why certain products can be so beneficial.

The skin ages by getting thin (loss of collagen and extracellular matrix), losing elasticity (loss of the protein elastin). This leads to lines and wrinkles and an overall loss of firmness. This process starts in our 30s and progressed rapidly during our 40s and beyond.

The skin also gets discolored. Brown pigment (from melanin deposits) and redness (from broken capillaries) result from years of accumulated sun exposure. Dullness and loss of skin brightness (luminosity) happen as a result of the accumulation of dead skin on the outer surface of the skin (epidermis).

Once you know what the problems are, you can look for treatments and skin care that target these problems. Many of the changes can be treated at home once you are on the right skin care program, while others require treatments in our office.

We offer complimentary skin care evaluations to make sure everyone gets started on the right plan.

In a nutshell, I have arrived at the conclusion that there is a core group of products that form a solid foundation of a results-based skin rejuvenation and prevention program. Everyone  regardless of age should be on one of these. The combination, of course, would be tailored to your specific needs.

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The Acronym GRASS Helps us Remember the Products Categories.

(G) Growth Factors (R) Retinol/Retin-A

These two categories work together to treat thinning skin: These products help stimulate collagen, elastin, and extracellular matrix. The net effect is the skin thickens over time and has fewer lines and wrinkles. These products truly renew and rejuvenate the actual skin and the expression of the genes that are seen in young skin. Time tested and backed by science and actual results.

(A)Antioxidants: Vitamin C and E fight free radical damage and keep our cells healthy and help reduce cell mutations that can lead to skin cancer and skin aging.

This is an integral part of good skin health. Not all products are the same. It is important to use a product that can actually deliver the products to the cells as opposed to sitting on the surface of the skin.

(S)Sunscreen: This is one of the most important categories to get right. Despite the fact that many do use sunscreen, it is unfortunate that many are on the wrong sunscreen. The sun has a combination of UVA and UVB radiation, most sunscreens are chemically-based and block UVB light. UVB is responsible for sunburns, tanning, and skin cancer. However, UVA light is what causes sun damage and skin aging. This is blocked by a physical blocker like zinc or titanium oxide. The only sunscreens you should use are broad-spectrum sunscreens that block both UVA and UVB light.

(S) Specialty products: this category is all the other things that can be added to meet your specific needs.

  • Lighting agents are used to decrease brown pigmentation, melasma, and sun damage
  • Alpha hydroxy Acids/Beta hydroxy acids are used to help with exfoliation of the upper skin so your skin can appear more bright.
  • The clarisonic brush is used to fully clean the skin and mildly exfoliate.
  • Eye Cream is used to help reduce fine lines and wrinkles around the eyes. This is used in addition to growth factors and retinol. 
  • Latisse helps darken, thicken, and lengthen eyelashes. This product has nothing to do with the skin but can have a major impact on looking more youthful.

Personally, I have never felt so excited and hopeful about the treatment options we have for helping every patient get their glowing and youthful skin back or to preserve it.

I would encourage you to make an appointment to have a skin care evaluation. For those who come in for your post op appointments, Botox and fillers, and skin treatments we can always talk about it then as well.

Dr. Karam


Francine M.

Kris R.

Janice S.

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