Watch:
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From subtle tweaks to surgical transformations, Dr. Carrie Houssock and Lindsey explore non-surgical options and set realistic expectations for what injectables, lasers, and other treatments can do.
But when is surgery the better choice? Dr. Houssock explains why some results simply aren’t possible without it and how combining both approaches can deliver the best outcomes.
Anti-aging isn’t a one-time fix—it’s a long-term commitment. Starting early with the right treatments can help delay the need for more invasive procedures later. Consistency is everything in skin care, and they reveal the must-have ingredients to keep your skin looking its best.
Find out which treatments are right for your age—preventative treatments in your 30s, maintenance in your 40s, and restorative treatments in your 50s and beyond. And hear Lindsey’s thought process on when it’s time to send you to Dr. Houssock for surgery.
Learn more about non-surgical facial rejuvenation options at JEV Plastic Surgery.
Learn more about facelift with Baltimore plastic surgeon Dr. Carrie Houssock.
Transcript
Dr. Houssock (00:04):
You are listening to another episode of Perfectly Imperfect. Welcome to the Perfectly Imperfect podcast.
Lindsey (00:11):
Thank you so much.
Dr. Houssock (00:12):
Lindsey is a frequenter here. We like to do our podcast with a specific topic in mind, and usually I will have the staff member or who really kind of jives with that topic. And today’s topic is a very big one, and so we’re not even going to be able to even skim the surface of the details of facial aesthetics, right? But we’ll try. We’ll try and we kind of chatted a bit before this, just a little bit, just off the cuff. That happens a lot to Lindsey and I. And really one of the big things that we were talking about was in a practice where we do both surgical and nonsurgical treatments and specifically in facial aesthetics, how do we guide our patients when we’ve got it all at our fingertips? We’re lucky enough to have all the nonsurgical and then all the surgical. How do we guide our patients to make the right decisions for them where they are doing the right non surgicals, but ultimately knowing when what they need or want has gotten to the surgical level.
(01:17):
And so I think that’s a really kind of great way to segue into this episode in the sense that we kind of break down the nonsurgical in a preventative portion of nonsurgical and a restorative and treatment. And so there’s a difference between those two things and what we would expect from them, but they’re probably equally important and neither of them replace surgery. So to say it one more time, we’ve got nonsurgical preventative, we’ve got nonsurgical treatment or restorative, and then we have surgical rejuvenation. Alright, Linds, you get a new patient. We’re going to go total preventative. This patient is in her early thirties, late twenties, early thirties. She is very interested in some type of preventative maintenance. Right now all she’s had is some skincare. She takes care of herself in the sense that she does a daily skincare regimen, but so far it’s been stuff from Sephora. It’s good stuff, but she knows that that only takes her so far. And so she’s coming in and wants to set up a regimen with you as to how she can prevent forward thinking, preventative aging. Set me up with that consult.
Lindsey (02:45):
So you’ve got a few different options, a few different ways to tackle it. One, if muscle movement is a problem, elevens, forehead lines, crow’s feet, pretty common in that age group. We could certainly do some Botox or Dysport. She probably wouldn’t need a lot, but we’d be doing a little bit just to keep those lines from becoming static or there all the time. That’s when they get harder to treat. So when we get into our forties and fifties and someone comes in with really deep 11 lines that are there at rest, it gets a little harder to get those to go away fully. So if we start a little earlier, even with a little bit, we help ourselves later. Part two would be microneedling. So everyone could do a little bit of microneedling. Virtue microneedling would probably be my preference for her. If we don’t have any major things to tackle. Virtue’s a little more comfortable, she doesn’t need a driver to drive her in for it.
(03:34):
Probably don’t need to get into jowls or fat pad under here. So I don’t need the power of the Morpheus for her. And we can just do a series of those, and then maybe once a year she gets a single one. As preventive maintenance. We’re all losing about 1% of collagen a year. And so what we’re trying to do is build her a little bit of that back and prevent her from losing all of that collagen over the next 10 to 20 years. Third thing, CoolPeel. If there’s anything at the surface, CoolPeel is nice. CoolPeel is your CO2 laser, almost like a resurfacing for the skin. And so that’s a nice treatment that people can do a single every year, every 18 months. Kind of more flexible with that one just to give yourself a nice little glow, a little resurfacing. So those are really three very nice things that people can do. The other side of it is better skincare. That’s kind of the going to the dentist, brushing your teeth every day.
(04:26):
So if you dabble into anything where you’re spending money, you should also be brushing your teeth every day. Very basic though, a little daily power defense, maybe a light retinol. If there’s any issues, issues with browns, issues with reds, then maybe we add a product for those. Maybe a simple growth factor. We don’t need to go crazy with somebody like that. We really try to tailor their regimen to what they’re looking for. And so sometimes people will come up with, oh, I am a little dry. Okay, maybe use an HA immerse an HA five. You’ve got things that you can add in, but keep it simple. Don’t go crazy.
Dr. Houssock (05:00):
Yeah. Basically, it’s just simple things that are going to go a long way, long term. It’s kind like an investment. You think about if you’re investing your money, it’s a slow and steady growth. So it’s the same thing with a patient like that where we’re getting them at an early stage in their life. They haven’t done a ton of damage yet. I will say these days, the generation that is in their twenties and thirties, they’re a little smarter than we were.
Lindsey (05:25):
They definitely are.
Dr. Houssock (05:28):
They know more now. People are coming into our practice having known that they have to watch their sun damage. They are doing skincare early in life. And so we are getting them at a really great time. And I would argue, and so would Lindsey, is that obviously just like every part of medicine, it is much easier to prevent a disease than to treat one.
(05:49):
So that goes the same when it comes to aging. So it’s really no different than when we talk about preventing heart disease. It’s easier to prevent heart disease than to treat heart disease. Same thing when it comes to aging. I mean, it’s all part of the body. So if we can get you early and get you doing the right regimen early, I will argue, and Lindsey hears me say this all the time, watching what we watch now, I will argue that if you are a good preventer early on in life, there’s a really good chance I’m not even going to get to see you in the operating room, which stinks for me, but really is awesome for patients, right?
Lindsey (06:26):
Yeah.
Dr. Houssock (06:27):
It’s a real possibility.
Lindsey (06:28):
Or it’s decades later than it would’ve been.
Dr. Houssock (06:30):
Correct, or it’s not nearly at the level that they would’ve needed it before. And so absolutely early on, it is so smart. She did mention a bunch of skincare things that we would suggest at home, but the major gestalt of that is, oh, you’re going to cleanse, you are going to use an antioxidant, that was what the daily power defense would be. So vitamin C or Daily Power Defense, Daily Power Defense is one of our favorite ZO products. Ultimately those are the two that are rock hard. Then if you use a growth factor, that’s just going to help you build collagen. We all need collagen. And then finally, sunscreen. So very simple. It doesn’t have to be hard. It definitely doesn’t. Do we have all kinds of stuff? Sure we do. But when you’re at a younger age and we’re talking prevention, we’re still that prevention patient. You don’t need to be doing a ton, but you need to be consistent, right?
Lindsey (07:19):
Yep. And I sometimes find in those people in particular doing too many things, you actually cause more problems. Now you’re creating an oily situation. You’re more dry than you should be. You’re just doing too many things. So keeping it simple many times is much better.
Dr. Houssock (07:35):
And why you need to go to a specific professional place, medical grade to do that is because we are also seeing very young girls using things from Sephora and injuring their skin. And that’s a problem, that will have its own problems, really. So again, we’re not against Sephora, but you have to just know that all of these things, if they’re strong enough, they can also create problems if they’re not right for your skin.
Lindsey (08:00):
Or if you overuse them.
Dr. Houssock (08:01):
Yes, yes.
Lindsey (08:02):
Overuse is a big issue.
Dr. Houssock (08:03):
Yes, totally. Over exfoliating. Over moisturizing. Totally. So, alright, so that’s that patient population. Next patient. So now this patient is in her mid forties. She really didn’t do a whole lot when she was younger except for the stuff that we all weren’t supposed to. She was in the sun a lot, so has a lot of sun damage. She also dabbled with some skincare stuff, but for the most part she’s just wearing makeup as a camouflage. She’s open to doing some skincare at home, but she hasn’t really done a whole lot of that. At this point, she’s got some, her skin is thinning, she does have some wrinkles starting to show on static, meaning that she is not moving her face ,when she doesn’t move her face, she has some wrinkles on her forehead, in her crow’s feet. She has some pigmentation, so some brown spots from the sun. And all these things are concerning to her and she’s willing to invest time and money into improving them. And so she comes to you kind of saying, alright, I’m ready to now behave myself. I’m going to listen and I’m going to do the right thing. But also, how do we now prevent me from getting worse because I’ve got some stuff, but I am still in my forties. I’m not that old. But now we’re also talking about doing some restorative treatment, fixing some things that have already happened. Let’s talk about how we handle her.
Lindsey (09:20):
Starting with the static lines. Easiest fix for those, again, Botox, Dysport. We can do those in crow’s feet, forehead, glabella lines, wherever we need it.
Dr. Houssock (09:29):
How long is that going to take to help and fix that?
Lindsey (09:32):
It depends on how deep those static lines are. I always tell people up to a year, year of consecutive treatment could be, especially at that age, depending on how deep they are, but they might notice some softening immediately. And then for them to really go away, it might take a little while and that’s okay, but then we’d use other things in conjunction with that. So for someone like her with pigment and some fine lines, wrinkles, the one, two punch of a photo facial, CoolPeel, a hundred percent. IPL photo facial browns and reds picks up the reds any vessels and closes them down. The browns look like pepper flakes is how I always describe it, and then they sort of flake off. CoolPeel comes over top, working on the collagen, working on the fine lines and wrinkles. I can also get some pigment lift with that.
(10:15):
So some of the deeper pigments, sometimes I can get in there and break that up. That’s an easy one. That she might need a series of depending on how much pigment we’re dealing with, how much sun damage we’re dealing with. But could be a one two punch of a single treatment, could be a series, don’t know. And then something like Brightalive for a product, something like nectar for a product, nectar is a good collagen builder, collagen repair down in that deep dermal layer. It gets down in there and fixes all the collagen damage that she’s got going on. It also helps with her downtime after something like a photo facial, CoolPeel. And then she can also consider microneedling. But if pigment’s the primary I’d start with those and then decide if we want some more tightening, if we want to close down pores. Anything else that we could tackle with microneedling.
Dr. Houssock (10:59):
Yeah, it’s one of those things where we wish that we had the one treatment fixes all, but it’s just not that simple. And unfortunately, that’s why it’s so valuable to sit down with Lindsey before you make your plan because one person’s issues might be somebody else’s non issue, I mean some people just don’t have that. And so you have to cater to them. We love CoolPeel, we love Morphus8, but if you’re coming in and you’re saying, my biggest concern are these brown spots, well to this day, there’s nothing better than IPL to combat pigmentation. IPL has been around forever and ever and ever. And there’s still nothing better than that when it comes to reds and browns. So while your friend might be going crazy with Morpheus8, if your biggest concern right this moment is pigmentation, then yes, we love Morpheus8, for texture tone building collagen.
(11:45):
It’s not going to really tackle those pigments like it would with an IPL. So that matters. And then if she moving forward, once you get her in the right place, so let’s say you do a series of IPL, her pigmentation is much improved. She’s doing the Botox every three to four months because unfortunately Botox is forever. If you want to keep your lines from coming back, you have to continue to do them. She’s doing her regimen of every three to four months. Her pigmentation is improved. Is there anything different that you would do with her skincare that you didn’t do with the 20 something, 30 something?
Lindsey (12:18):
Probably a little bit more heavy on the retinol, lean on that a little bit more. Really just depending on her particular issues, addressing each single issue. So you just are upping the ante a little bit. I don’t think it’s necessarily that you need 20 different things. You just might need a more powerful one of the things.
Dr. Houssock (12:34):
Yep, that makes sense.
Lindsey (12:35):
If that makes sense.
Dr. Houssock (12:36):
Any vitamin A derivative, the retinols, the tretinoins, they’re going to be the single best thing we’ve got topically for anti-aging in the world. There’s nothing better than that. We have all these fancy serums and you’ll see this stuff from other countries. They’ll be using snail serum and there’s growth factors and that’s all well and good. And you know what? They might work, but there’s nothing as good as vitamin A derivatives, period for anti-aging. And that is because it turns over the skin cells to build collagen. Oh, we keep saying it, building collagen, building collagen. But that’s what makes you youthful. That’s also keeps you from sagging and having laxity. And so for all those reasons, we’re always combating losing collagen for every reason. And so definitely I always say that that patient population, if you make me choose one thing you’re going to be doing, it’s going to be a vitamin A derivative, it’s going to be a retinol or a tretinoin, hands down.
(13:25):
And again, yes, it’s forever. People ask, how long do I have to do this stuff? We’re going to age. We don’t stop aging. We don’t freeze in time. So we do have to have upkeep unfortunately. And I do also truly believe that you have to look at it as a long-term investment. There is no point in coming in here and getting a single Botox treatment and spending your money on that if you’re not going to continue it. That’s just the unfortunate truth of this is that this is something that you have to do long term. And Lindsey’s patients, it’s just like seeing your primary care. At this point, Lindsey’s career, she has patients who come in and see her regularly. Some of them every three to four months, some of them every six months, some of them yearly. But it’s just as much as patients have their yearly visit with their OB GYN or their primary care, you also have, if this is important to you, you will have a visit with your provider who is doing your anti-aging.
(14:17):
It’s just the way it is. Alright, so final group is someone who is in their sixties. She has significant skin laxity. She also has had significant loss of volume. We’re going to do an A and a B on this, this particular one, she’s not wanting to entertain something surgical. So she really just understands that where she is and what her age is, and again, hasn’t been the best at doing stuff up until now, but is willing to invest the time into something, but it’s going to be the nonsurgical. So talk me through how you educate her and what you might suggest for somebody in their mid to upper sixties who hasn’t done anything yet.
Lindsey (15:01):
Typically in that age range, we’re talking Morpheus8. Usually at that point we have some jowling and usually that’s a big concern. Lower face area, a hundred percent. And the jowling here, that becomes a problem. So I am limited in what I can do non surgically, and a lot of my consultation explains that I cannot pull skin back. I cannot get rid of completely. I can soften, I can camouflage, I can work around all of these things, but I can’t get rid of the excess skin. And many times at that point there is excess skin. And so that is the distinction between surgery in my mind and non surgical. I can’t cut the excess skin away, can’t do it. So I have to go in and try to melt the fat with Morpheus that’s in the jowl, tighten along the jawline, tighten along the midface. Sometimes I’ll use filler in the midface because as we lose volume here, we can fill this and get more lift here. That’s sometimes.
Dr. Houssock (15:58):
The youthful V.
Lindsey (15:58):
The youthful V. Sometimes I’ll come in the lateral cheek with a little bit of filler, nasal labial fold with a little bit of filler, down in here with a little bit of filler and just try to soften those points to get a little bit more youthful appearance.
(16:12):
But again, it is minimal in what it can do depending on how much skin fall there is.
Dr. Houssock (16:17):
It’s like an expectation thing.
Lindsey (16:18):
It’s just the reality.
Dr. Houssock (16:20):
You have to be able to understand that if you’re, yes, there’s some improvements that we can make at that level, but Lindsey will be very honest with what she can and cannot achieve. And really for patients, they have to decide if it’s worth what they’re going to achieve. You cannot have a surgical result from a non-surgical treatment. There is not a single thing. And again, we offer it all. So we can say this comfortably, there is no non-surgical item that can give you the result of a surgery. Nothing in no way. It just doesn’t exist yet. And if it does, we’re really excited about it because listen, there’s no question that surgery comes with risk. So if we don’t have to do that, we of course would love to avoid it. Unfortunately, and it also comes with downtime and recovery and all of that, so that’s well and good, but one of the things Lindsey and I had chatted about earlier today is that we’ve realized that we have things that work in synergy. We work really well together, her non-surgical practice, my surgical practice, but there’s really no good non-surgical thing that can replace what I do. It can only work together to maybe ultimately make the best result. But so for that patient who’s in their sixties, it doesn’t mean that she, Lindsey has a bustling practice of women who are in their sixties and seventies, even in their eighties.
Lindsey (17:37):
Eighties.
Dr. Houssock (17:37):
Who see her regularly and obtain non-surgical treatments and are very happy because the limitations are understood and the expectations are met and they are pleased as pie after they see Lindsey and get what they can get done. So it happens all the time. You have a huge practice of patients who are in that group. It doesn’t mean that you can’t do it, you just have to have the proper expectation.
Lindsey (18:08):
And it has to be worth the spend of money at that point.
Dr. Houssock (18:11):
Yeah, absolutely.
Lindsey (18:12):
Most of the time at that point you’re not working anymore. And so the reality is there is a fixed income, so we need to be aware of that. And so if I’m very clear on what you can get, then you can make a good decision, an educated decision of that will make me happy or that’s not really what I’m looking for. Okay, that’s okay too. And so I never minimize that with people too. And I think there’s a level of respect there, because I will be very honest with what I can do. I tend to under promise, over deliver because if you’re going to be happy with my under promise when I can provide a little bit more, you’ll be even happier.
Dr. Houssock (18:47):
Go to that next level then, Linds. So we’ve got that same patient, the 60 something year old, but she’s the type B where she is open to whatever, including surgery, and she’s just coming in to get your recommendation. Where do I start? What do you think? And so let’s talk through that same scenario, but this time she’s open to it all.
Lindsey (19:05):
So many times we sort of work together on this one. So most of the time this patient comes in and will say to me, I’m just looking for something. And they take their face and they go like this, something like this. And I’m like, that’s a facelift, what you just did. So this motion to me where there’s skin laxity at the ear, you’ve got skin that you’re pooling back, that’s a facelift. And so right up front that’s a facelift. And we can certainly work on skin texture, we can do a CoolPeel or a DEKA pulse CoolPeel, CO2 lasers.
Dr. Houssock (19:39):
What’s that? Heavier?
Lindsey (19:40):
Heavier, deeper resurfacing while you’re asleep. Why not? But at this point, you really do need to meet with Dr. H. And so many times we will start the conversation of some nonsurgical options, but then we’ll come in, set them up for a consult with you surgically, and then we can always reconvene on the nonsurgical. But if their primary really is that motion of skin, I’m not going to fix that any other way. So primary is figure out your facelift.
Dr. Houssock (20:08):
That’s exactly it. And so patients will ask, okay, well, can I buy some time? Well, here’s the thing, you can do the Morpheus. I will tell you that I’m still in the camp of, you can still do the heat based treatments and also have a facelift. You will find that there are some surgeons out there who are really against doing any kind of radiofrequency, Morpheus8 any of that stuff before you have a surgical operation if it’s planned. But I would tell you, I’m not in that camp, I’ve done enough facelifts with patients who have had treatments before and feel comfortable with that plane. But I would argue if you know you’re going to go down that route, there’s only so much that you’re going to get out of that. So maybe you just save that investment to do some things at the same time, like Lindsey’s saying. Also, depending on how you’re coming to us, if you have done nothing to your skin and your skin is significantly damaged, has very little collagen, you’ve never done skincare, I will tell patients that they have to do some nonsurgical to make the skin as healthy as possible before they undergo a facelift. And that’s just number one, because it’ll be the best result, but ultimately it’s going to be the longest outcome for you too. That doesn’t happen a lot, but it does happen sometimes. And we’ll be honest about that.
Lindsey (21:22):
It does, but also then we’re able to lay it out for you. You’ve got a plan. Okay, so you’re going to do this for the first three months, then you’re going to wait 6, 8, 9 months, whatever we decide. And then you can come in for your facelift. So at least you have your plan laid out, and I think that’s helpful for people.
Dr. Houssock (21:36):
Yeah. Yep, totally. I think a lot of people love that. They don’t mind the wait as long they’ve waited this long, as long as they’re doing the right thing, and we want you to get some miles out of your surgery if you decide to do it right? So we have to be smart about that. So ultimately that is kind of how it runs in our practice. And again, we are very fortunate in that we can provide it all where you might go to a surgical practice and they just do surgery. So that’s what they know and that’s obviously great. Or if you go to a dermatologist or a medi spa where all they’re doing is the nonsurgical, again, great, but ultimately they can only take you so far. And so they might hold onto you a little longer because they don’t want to lose you and then you really are ready for surgery.
(22:23):
I would say that’s becoming more common to see a kind of combinations practices where that’s happening. It’s a benefit to a patient because in the end, if you’re trusting, if you’re with Lindsey for years and years and years, and then finally she gets to the point where she’s like, listen, I think it’s time to start talking surgery, then you know that she’s going to send you somewhere where she knows that you’re going to get taken care of and you don’t have to be worried about where you are because we’ve all kind of been a part of your journey to begin with. And sometimes she will grab me and I’ll grab her. I’ll say, Hey, I’ve got somebody I think that they, and so on and so forth. And she mentioned, just to touch on that combination thing, we often do that where I will be operating on a patient in the OR and then Lindsey is also doing treatments at the same time. That is very common, more common than not, especially when it comes to face. It’s very rare for me to do a facial procedure surgically where Lindsey isn’t also doing something to them in the OR. They work together, they work in synergy.
Lindsey (23:18):
The other area is the under eye, just to touch on that, because you’ve got blepharoplasty to remove the excess fat and skin there. But then I’ve got CO2 for the crepey skin. I’ve got micro needling for the crepey skin. We’ve got filler if there is a deficit in volume. So it’s another area, it really depends on what the issue is as to how we may steer you. And that issue may change with age.
Dr. Houssock (23:43):
Right.
Lindsey (23:43):
And so sometimes we’ve been with someone for many years and then all of a sudden it’s like, now it’s morphed into this problem and now we’ve got another thing that we need to deal with. So it’s always changing with face. And so it’s one of those things as we age and as things shift and change that we’re just very honest about.
Dr. Houssock (24:00):
We need more things. We need new things,
(24:02):
It’s, it’s not just volume. It’s not just skin laxity. It’s a combination of those. It’s also texture. So you have to kind of pull from different places. And especially in the under eye, one treatment does not treat all problems. Filler does not treat all problems. The blepharoplasty does not treat all problems. It depends on your problem. And where things have gotten sticky lately in the world of non-surgical aesthetics is people thinking that filler can treat all under eye issues. And actually it’s the complete opposite. It can really make things worse if it’s being done in the wrong patient. In the right patient, oh my gosh, Lindsey can do an amazing job in the tear trough when it’s the right thing. When it’s not the right thing, and unfortunately, where we see that often is patients coming from other places. And it’s, again, no offense to other practitioners, but filler doesn’t fix skin laxity in the eye. Filler does not fix crepiness in the eye. And so when used in those situations, unfortunately, filler actually makes the situation worse.
Lindsey (25:02):
It is a tricky area to fix as well.
Dr. Houssock (25:05):
Very.
Lindsey (25:05):
Yes, I can dissolve. Yes, I can replace where it needs to be replaced and finagle things, but it is usually there’s some amount of swelling, a little bit of puffiness that remains.
Dr. Houssock (25:16):
Yes, just use caution. We love filler in the tear trough when it’s the right thing. But if you are seeing someone brand new and you’ve never had filler before and this is your first visit and someone wants to start putting filler in your tear trough, I would just be very cautious. It is the kind of place that should be used with very tender hands because we’ve seen it time and time again. And unfortunately, sometimes you do just need me, unfortunately. It’s just the way it is. And I’ve even had situations where I’ve had to go to the, OR to remove, people have had fat grafting in that area when they didn’t need volume, and I’ve had to go to the OR remove that. So just being smart and making sure that you’re looking at all things and you have to be your own advocate. Even unfortunately in the world of aesthetics, less is really is more, less is more.
(25:58):
And you have to be cautious at all times because sometimes it’s not the right treatment for you. So anywho, I love what we did today, I love that we kind of took, here’s the scenario, which scenario are you? And hopefully we can guide patients into if they’re one of those scenarios, what they should be looking for when they go and they see their provider for the first time. I think it’s important to go in with just a little bit of knowledge, and then hopefully you’re with somebody who you trust and then they can kind of take it from there.
Lindsey (26:27):
Yep, agreed.
Dr. Houssock (26:29):
Awesome, Lindsey, well carry on.
Lindsey (26:31):
Carry on. Dr. Houssock,
Dr. Houssock (26:34):
Perfectly Imperfect is the authentically human podcast navigating the realities of aesthetic medicine. JEV Plastic Surgery is located, Owings Mills, Maryland. To learn more about us, go to jevplasticsurgery.com or follow us on Instagram @DrCareHoussock, spelled D-R-C-A-R-E-H-O-U-S-S-O-C-K, or just look in the show notes for links. If you enjoyed this episode, please share it and subscribe to Perfectly Imperfect on YouTube, Apple Podcasts, Spotify, or wherever you’d like to listen to podcasts.