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Most of us are super-tuned-in to the first signs of aging on our faces. (Isn’t that why the mirror was invented?!) All the while, the hands are more likely to betray our ages.

Just like the face, the soft tissue in our hands that gives them volume gradually diminishes as we age, which makes the veins, tendons, and bones much more prominent.

Our hands also see as much sun as our faces, sometimes even more. The face is the first place we’ll apply sunblock, in large part because we’re so sensitized now to the sun’s aging effects, but who thinks about protecting their hands? We really should, because all that exposure can lead to hyperpigmentation as we age.

Hindsight is 20/20. Fortunately, there’s a range of remedies that’ll undo the ravages of time and leave your hands looking as young as you feel.

Hyperpigmentation treatments

Topical skin care products for home use are the least aggressive track to help combat hyperpigmentation.  We know there’s no shortage of over-the-counter serums, peels, and creams that treat sunspots and pimple marks, but if you’re truly bothered by those dark spots, the best thing you can do is see a board-certified plastic surgeon because they’re all far more effective after a plastic surgeon’s been able to lift and lighten the brown with professional-strength chemical peels and calibrated lasers.

A plastic surgeon with lots of experience in treating hyperpigmentation will know to be very careful with their approach. Even a well-meaning laser can ignite pigment rather than extinguish it. The least aggressive tack by a plastic surgeon or medical aesthetician is usually a series of mild chemical peels. For dense spots, lasers are more effective, such as IPL – intense pulsed light.

Dermal filler

Restylane Lyft, a hyaluronic acid filler, made headlines last year when it became the first injectable of its kind to be approved by the FDA for use outside of the face.

An injection underneath the skin on the back of the hands but above the connective tissue that covers the tendons, bones, blood vessels, and nerves has been shown to improve age-related volume loss for up to six months.

There may be some mild swelling, tenderness, or itching afterward, but it’s typically short-lived.

Fat transfer

An autologous fat transplantation, or, simply, a fat transfer, is a cosmetic surgical procedure where your own processed fat is used to re-contour and smooth your hands.

Fat cells are removed by liposuction—usually from around the belly button or the thighs or buttocks—with a small needle attached to syringe. They’re then sterilized and processed and injected into the back of the hands.

Generally, the results from fat transfer is about 50% permanency, and you could possibly want a second treatment to reach your desired look.

A topical or local anesthesia is applied to the area where the fat cells are taken from and the backs of the hands. The procedure should only take an hour or so, about 10 to 15 minutes to remove the fat cells and then another five to 20 to inject them into each hand. The results can last up to several years.

In an earlier post, I discussed how to go about restoring a more youthful appearance to aging eyes through cosmetic surgery. Here, I’ll get into a less invasive approach: under-eye dermal fillers.

As we age, those dark circles under our eyes become more pronounced. Doctors call them tear troughs. The skin around your eyes is thinner and paler and lacking the proper fat restores, so the indentations grow a little deeper, giving the eyes a more tired appearance, even if you feel as vibrant as you did 20 years ago.

It’s a pretty common issue. Everyone has a natural indentation above the rim of the bone that encircles the eye, but some are deeper than others. Thank your parents. Those dark circles can also be affected by sun exposure, allergies, dehydration, and insufficient sleep. So there are natural ways to stave them off, like wearing sunblock, staying hydrated, and getting enough sleep, but dark circles will still worsen as we age.

The wonder that is hyaluronic acid

Enter under-eye dermal fillers. They’re injectable treatments of hyaluronic acid—the most common brand names are Juvederm and Restylane —that stimulate the appearance of thicker fat pads under the skin.

Hyaluronic acid is a natural part of the skin’s dermis, but it diminishes as we age, which causes the undesired hollowing effect under the eyes. The hyaluronic acid in fillers helps pull water to the site of the injection, creating a plumper under-eye.

A series of injections are placed under your eyes. A topical numbing agent can be applied beforehand to ease any discomfort, but the injections are virtually painless. (It’s a very small needle.) In all, the procedure should only take about a half-hour. The cost starts around $300 with individually tailored treatment plans, and the results last up to a year.

The recovery is minimal: You’ll need to avoid intense exercise for the first 24 hours, and you may need to ice your under-eyes if you start to feel any discomfort around the injection sites. That should be the full extent of it.

Experience still matters

As simple as the procedure may sound, it’s important to find a board-certified plastic surgeon that has lots of experience injecting under the eyes.

No two fillers behave exactly the same way. So it’s crucial that the injector understands the differences between the products and the areas where they’re most appropriate. Use the wrong filler in the under-eye area and you’ll run the risk of creating an unnatural look or creating an even bigger problem.

The right product in the right hands, however, could restore years to your appearance in less than an hour.

As we anxiously await some more pleasant weather, it feels like the right time to discuss updating your skin protection regimen. It turns out, the sun isn’t the only threat, and you don’t even need to set foot outside to feel the effects of another.

I’m talking about blue light. The main source of our exposure to it is the sun, but we’re also getting our fill of it from our screens and indoor lighting. It’s been garnering increasing attention over the last few years after a few small but potentially groundbreaking studies came to light.

One found that exposing skin to the amount of blue light we get from the sun caused more pigment, redness, and swelling than when the same person’s skin was exposed to comparable levels of UVA rays. Another suggested that blue light might stimulate the production of free radicals in skin, which can speed up the appearance of aging.

Let’s unpack that and discuss what you can do about it.

How damaging is blue light, exactly?

Blue light isn’t all bad, actually. It helps regulate our natural sleep-wake cycle, for one. (Though, too much of it may make it more difficult to fall asleep.) It’s also been found to elevate mood and help memory and cognitive function.

But that early research I referenced doesn’t paint such an inviting picture. A lot more research still needs to be done before we can draw any meaningful conclusions, but the evidence so far does seem to suggest that it has the potential to be damaging to our skin.

Some of that has found that as blue light penetrates the skin, it leads to DNA damage, which spurs inflammation and the breakdown of healthy collagen and elastin, along with hyperpigmentation.

It’s still hard to say whether our screens produce enough blue light to cause serious skin damage. Though, it’s not hard to envision a scenario where the longer we spend on our devices, the worse off our skin might be. And make no mistake; we’re spending a lot of time on our devices. A 2016 report found that adults log more than 10 hours of screen time a day.

At least one prominent dermatologist has been quoted as saying, “Spending four eight-hour workdays in front of a computer screen exposes you to the same amount of energy as 20 minutes in the midday sun.”

What can you do about it?

Before we discuss your skin protection regimen, find the “night shift” (or “night mode”) setting on your phone and tablet and set it to run all the time. That’ll effectively disable the blue light emissions from those devices.

Now, as for your regimen, a quick search will yield lots of new topical antioxidants that are designed to boost our skin’s natural defense system against blue light and environmental stressors. I offer what I believe to be the most effective formula on the market, SkinMedica’s LUMIVIVE. It’s billed as “full atmospheric protection against blue light and pollution.”

LUMIVIVE is a two-step system. The Day Damage Defense Serum provides protection all day long while the Night Revitalize Repair Complex enhances the critical sleep-repair cycle. Together, they can offset the 10 hours, on average, we spend in front of a screen each day and restore your skin’s radiant glow within 14 days.

In time, it may become as essential as your broad-spectrum SPF.

The face you see looking back at you in the mirror as you remove your makeup each night, does it look tired?

Inside, you may feel as vibrant as you did in your twenties. But your eyes are telling a different story to everyone you come in contact with.

Cosmetic eyelid surgery is a way to align those two versions of yourself. It restores a more refreshed and naturally youthful appearance to aging eyes.

Here’s what eyelid surgery, or blepharoplasty, can treat:

• Loose or sagging skin that creates folds around the upper eyelid
• Fatty deposits that appear as puffiness in the eyelids
• Bags under the eyes
• Drooping lower eyelids
• Excess skin and fine wrinkles of the lower eyelid

What’s eyelid surgery like?

Eyelid surgery can be performed on your upper eyelids, lower eyelids, or both. Your plastic surgeon will determine how much skin, and/or fat to remove based on a thorough pre-operative evaluation.

From there, your surgeon will make precise markings to indicate where the excess tissue will be removed. In the upper eyelid, the incision will be hidden in the natural fold of the upper eyelid. In the lower eyelid, it’ll be hidden just below the lower lashes. When excess fat is removed, the incision can also be placed inside the lower eyelid, in which case a laser is sometimes used to tighten the lower eyelid skin.

The excess tissue will be removed with scalpels, surgical scissors, radiofrequency cutting devices, and, sometimes, cutting lasers. Less tissue will be removed if you have dry eyes because exposing more of your eyes to air could worsen your symptoms.

Fat is sometimes redistributed in the lower eyelids to eliminate puffiness or bulges. In the process, your surgeon may also make adjustments to correct special issues, like muscle laxity.

Sutures or glue are then applied to smooth and reconfigure the areas around the eyebrows and eyelids. The sutures are invisible to the eye and usually self-dissolving. In most cases, there are virtually no detectable scars. A laser may also be used to resurface skin and smooth wrinkles in and around the eyelids.

The surgery is performed as an outpatient procedure and usually lasts between 45 minutes and two hours. Depending on the extent of yours, you’ll be given either general anesthesia or local anesthesia with IV sedation.

Eyelid surgery alone can significantly rejuvenate your appearance, but it’s also commonly combined with other complementary procedures, such as a facelift, brow lift, or both. A brow lift will address the sagging skin and deep furrows above the eyes, while a facelift will resolve jowling, sagging, and wrinkles on the cheeks and neck.

How about the recovery?

During the first few days to a week following eyelid surgery, it’s common for patients to have some visible bruising and swelling. Their eyelids may also feel unusually tight and more bothersome than normal. This can often be relieved with cold compresses.

Most are fit to return to work within five to seven days. For the first few weeks back, you can expect your eyes to get tired a little more quickly than usual. You’ll also need to avoid lifting, straining, and bending down to pick things up for about two weeks. And it’s critical that you protect your eyes from the sun and wind.

The effects of your eyelid surgery, with a healthy lifestyle and a good skincare regimen, should last for years. Nothing stops the aging process, but your results will age naturally with you.

Botox injections are the fastest-growing cosmetic procedure at the moment. Last year, almost 7.5 million of them were performed in the United States, according to the American Society of Plastic Surgeons. That’s an 845 percent increase over 2000.

So, its power to reduce fine lines and wrinkles is real. But that’s not the only reason for its explosive growth. Did you know doctors also use Botox to treat migraines and hyperhidrosis (excessive sweating)? In fact, Botox was originally used to treat migraines. Later on, doctors realized it also smoothed wrinkles.

Migraine relief

The FDA, in 2010, approved Botox as a treatment for chronic migraines in adults 18 and over, meaning that you need to experience a headache on 15 or more days of the month. (It’s considered an “off-label” treatment for kids and adolescents, which means it can be prescribed, but it may not be covered by insurance.)

Botox enters the nerve endings around where it’s injected and blocks the release of chemicals involved in pain transmission. Essentially, it halts a migraine before it has a chance to start. But it typically takes a couple of treatments for it to take effect, and the benefits seem to grow with each treatment cycle thereafter. (One treatment lasts 10 to 12 weeks.)

According to the American Migraine Foundation, patients reported that two Botox treatments reduced the number of their headache days by half.

A treatment usually takes about 20 minutes and entails 31 injections with a very small needle—it feels like a pinprick—in several key areas of the head and neck.

It’s covered by most insurance plans, including Medicare and Medicaid, but they typically require you to have first tried and failed to respond to two other preventative treatments.

No more sweating

Botox injections are a relatively new treatment for hyperhidrosis. The FDA approved it for those who sweat excessively from their armpits, but it may also be used “off-label” to reduce sweating from hands, feet, and the face.

Not unlike its application with migraine sufferers, Botox blocks the nerves responsible for activating your sweat glands. Normally, when your body temperature rises, your nervous system activates your sweat glands. It’s the body’s natural cooling method. But the nerves that send that signal are overactive in those with hyperhidrosis.

Botox essentially paralyzes those nerves and prevents the sweating, but only in the specific area where the Botox was injected. You’ll receive several injections with a fine needle that’ll form a sort of grid pattern around the area of concern. It’s a pretty simple procedure that can be done during an office visit. And you’ll be able to resume your day as soon as it’s done.

It’ll take between two and seven days to stop sweating in the treated area and up to two weeks for total dryness. But that dryness will last between four and 14 months (for the armpits).

Insurance providers usually cover the full cost, but, like the migraine treatments, they may ask that you try other options first, like a prescription antiperspirant.

The first hint of warmth can never come too soon. March, anymore, feels as long as two or three months. But, despite what the 10-day forecast may say, spring is on the horizon.

As welcome as that realization is, it’s usually chased by another more daunting one: What has the winter done to me? Buried under chunky sweaters and wooly hats, it’s easy to lose sight of just how harsh that bitter-cold air has been to our skin.

The combination of the cold, stiff winds and the dry air inside and out gradually robs our skin of vital moisture during the long winter months, which can have a long-term negative effect on its elasticity and health.

To counter those effects and begin to restore a healthy glow just in time for spring, I recommend a couple of minimally invasive treatments that can be done during an office visit.

Starting fresh

Microdermabrasion is a chemical-free procedure that removes the dead, dry outer layer of the skin to reveal fresh, healthy skin underneath. A machine with tiny crystals gently exfoliates the surface of your skin removing dead skin cells and debris. It can feel like a gritty facial massage.

It’s suitable for all skin types and colors, and it won’t cause any scarring or color changes.

Almost immediately, you’ll see and appreciate the difference. There are a few more benefits at work beneath the surface. For one, microdermabrasion can improve circulation deep within the skin. Better blood flow means the cells are receiving more oxygen and nutrients, which will gradually improve cell processes and, in turn, elasticity.

Removing dead skin and improving circulation also helps to not only unclog pores—which will improve the absorption of skincare products by up to 50 percent—but reduce the size of them.

Offsetting all that screen time

It turns out that winter’s threats to our skin go beyond the extreme elements outside. The research is still in its infancy, but a few groundbreaking studies have indicated that the blue light from our phone, tablet, and computer screens is leading to premature aging and hyperpigmentation.

A 2010 study found that exposing skin to the amount of blue light we get from the sun caused more pigment, redness, and swelling than when the same person’s skin was exposed to comparable levels of UVA rays. Another suggested that blue light might stimulate the production of free radicals in skin, which can speed up the appearance of aging.

Even if this is the first you’re hearing of the news, you may have already noticed the overnight-influx of cosmetic products that are intended to address these concerns. I offer what I believe to be the most effective formula on the market, SkinMedica’s LUMIVIVE. It’s described as “full atmospheric protection against blue light and pollution.”

LUMIVIVE is a two-step system. The Day Damage Defense Serum provides protection all day long against blue light and pollution while the Night Revitalize Repair Complex enhances the critical sleep-repair cycle. Together, they can offset the 10 hours, on average, we spend in front of a screen each day and restore your skin’s radiant glow within 14 days.

Forget what they say; restore a healthy glow and meet spring with your best face forward.

In the past, for all of its potential to transform, there was no getting around the long weeks of recovery that a tummy tuck requires. But that’s finally changing.

Recent advances have enabled new variations of the tummy tuck to be more efficient and easier to recover from while still effectively reshaping the midsection.

The mini tummy tuck and the drainless tummy tuck are two such advancements. Let’s take a closer look at them.

The mini tummy tuck

While there’s no universal definition for the mini tummy tuck, the procedure is used most commonly to remove loose skin from below the belly button. A mini tummy tuck scar is about half the size of one from a full tummy tuck, and it can be placed lower on the pubic bone so it’s less likely to be seen above a bikini line.

The mini tummy tuck can tighten the look of the lower belly, making it the ideal solution for women with a small but persistent pooch. It also affords more flexibility than the full tummy tuck, which is a procedure best performed once. The mini tummy tuck can be updated or even repeated, which makes it an option between pregnancies.

Generally, you’ll want to take it easy for a week to two weeks after the mini tummy tuck. By that point, the bruising and swelling should have subsided enough to allow you to return to work, but it may be another week or two before you’ll want to attempt anything strenuous.

The drainless tuck

Drains play a key role in a full tummy tuck, helping to rid the body of natural fluid buildup. They can, however, be a major inconvenience during the recovery process. And they come with their own set of risks.

The drainless tummy tuck basically combines liposuction with a full tummy tuck using a particular suturing technique that eliminates the needs for the drains. Liposuction is used to remove stubborn fat from isolated areas of the abdominal area, which tones and sculpts abdominal contours while minimizing the amount of surgical intervention that’s needed.

From there, an incision is made along the abdomen, through which the plastic surgeon can remove loose skin and tighten muscle tissue. The surgeon then uses a technique called progressive tension sutures to secure the abdominal skin to the underlying tissue layers. That creates a tighter bond, leaving little room for fluid build-up.

You should be able to return to work and light physical activity within a week or two of the surgery. And gradually, over the next several weeks, you’ll start to notice improvements in your body contours. In all, it’ll take about six to eight weeks for the final results to become visible.

No doubt you’ve heard about breast implants. And, if you’ve ever spent a few minutes Googling them, you also probably have a pretty good idea about what the procedure entails.

A breast lift may be less clear. Breast lift and breast augmentation (implant surgery) tend to be used interchangeably when, really, they’re two distinct procedures. The augmentation gets all the attention, but breast lift surgeries are outpacing implant surgeries by two to one, according to the American Society of Plastic Surgeons. So, clearly, there’s value in understanding the difference.

What’s a breast augmentation?

Just to make sure we’re starting on the same page, a breast augmentation refers to a breast implant surgery. They’re one in the same. It’s a cosmetic procedure where a silicone or saline implant is placed into the breast to enhance its size, shape, and volume.

Check out my earlier blog post for a more detailed description of the procedure and the differences between the two kinds of implants. But, for our purpose here, I’m going to keep this to more of a general overview. Like I said, most of us already have a pretty good running knowledge of breast augmentation.

While it remains popular among women who simply want to increase the overall size of their breasts, implants have helped with a much wider range of concerns over recent years, from correcting asymmetry and volume disparities to restoring fullness following pregnancy and significant weight loss to reconstructing a natural-looking breast following a mastectomy.

What’s a breast lift?

With a breast lift, the surgeon removes excess, stretched-out skin, reshapes the breast tissue, and raises the nipple and areola to a more forward position, creating a more youthful contour. The procedure doesn’t add volume, but it does make the breasts look firmer, perkier, and more youthful.

Women commonly have a breast lift following pregnancy and breastfeeding, or a significant weight-loss. We’re also seeing a growing number of women come forward who’ve had drooping or asymmetrical breasts since their teens. A lift can correct such an imbalance.

A breast lift is typically performed as an outpatient procedure using general anesthesia or local anesthesia and IV sedation. It takes about an hour or two. Afterward, most patients experience some soreness and swelling. They’re usually fit to return to work within a few days, as long as it isn’t too physically demanding, and to most normal activities within a week.

There’s no halting the aging process, but a breast lift (plus proper care) is capable of providing many years of perkier, more youthful breasts.

Can I have both?

Yes. In fact, it’s becoming pretty common to combine a lift with an augmentation.

Women who have had children generally benefit the most from the combined surgery because of the toll pregnancy and breastfeeding take on their bodies. Though, there’s a big upside for any woman who wants to boost the fullness and perkiness of her breasts to any degree. Talk to a board-certified plastic surgeon to learn more about how you could benefit.