When people have rejuvenation procedures performed, often they pay attention only to their face – they figure that people are only looking at their face. The problem with this thinking is if you do not treat the quality of the skin on the neck, chest, arms and hands, the result is what I call the Decade Disconnect.
Your face may look one age, and the rest of your body looks like a totally different decade. People looking at you experience this incongruity at a visceral level.
When my sons became young adults, they would talk about going to a bar, and they couldn’t tell how old a woman was – if she’d had good work done – without looking at her hands. A mismatched face and hands are dead giveaways for a cougar, they said. That was the genesis of my Decade Disconnect concept.
I use this concept to explain to patients why it is so important to invest in treating areas of the body in addition to the face. I tell them that as long as they watch their sun exposure on their body, maintaining youthful-looking non-facial skin requires less of an investment than the face does.
With the face you can treat so many different things – the cheekbones, the perioral area, etc. You have to keep up with your neurotoxins. That requires more maintenance than just improving the quality of the skin on the neck, chest and arms.
The hands usually need some volume as well, but only every two years or so. I tell patients if they want to invest in their overall appearance, it is not as expensive as they may think.
During consultations, my practice uses the HintMD system by HintMD (Pleasanton, Calif.), which allows you to design and coordinate a treatment plan over the course of a year. We tell patients that if they went to the dentist with a mouthful of rotten teeth, fixing them would require more than a single visit. My patients like building a comprehensive plan because they don’t necessarily know what they need, but most people want to make the investment in looking good, and they want to know all the elements that go into it.
Unless patients have been scouring the Internet and seen everything people are having done, they don’t tend to know all their options. Treating the body comprehensively is a very effective way to provide complete treatment, but it is like skincare, if you don’t have it available at your office, your patients will go right to Sephora and spend thousands of dollars.
To avoid the Decade Disconnect, we must ensure that there is a seamless transition between all body areas. We want everything to look like it is in the same decade.
My approach involves making sure that if you are doing any procedure on the face, you treat the neck, chest, forearms and hands as well.
I begin by re-volumizing where necessary. In particular, I am doing a lot of hyperdilute Radiesse (calcium hydroxylapatite/CaHa) from Merz Aesthetics (Raleigh, N.C.) in the neck, along the jawline and even in the décolletage. Then I follow it with an intense pulsed light (IPL) device because the patient already has anesthetic in the treatment areas.
Additionally, we do a lot of laser-assisted drug delivery to enhance recovery. We will do a Fraxel Dual treatment by Solta Medical (Hayward, Calif.) with settings that are not very dense (i.e. 25 J/cm2, treatment level 5, eight passes). We then topically apply hyperdilute Sculptra (poly-L-lactic acid) from Galderma (Fort Worth, Texas), along with platelet-rich plasma (PRP).
With this course of treatment we also get some effacement of fine lines and wrinkles with very little downtime. The Sculptra dilution is 7 cc of normal saline, 7 cc of water and 2 cc of plain lidocaine, for a total of 16 cc. Patients typically undergo two treatments spaced six weeks apart. We also do a lot of Cosmelan peels from Mesoestetic (Barcelona) off the face.
For the hands, I tend to use more Restylane Lyft (hyaluronic acid) from Galderma than CaHa because of the swelling that CaHa causes. I will typically blend Restylane Lyft (off-label) with 0.5 cc of 1% lidocaine. I inject one syringe per hand, then reevaluate in a month. The full complement of treatments takes 20 to 60 minutes, depending on the patient’s needs.
There is really no one who is contraindicated, unless a patient is unable to have laser or filler treatment in general. Good candidates are people who are interested in rejuvenation. If patients are interested in rejuvenating their face, they should be interested in rejuvenating every exposed body part. Otherwise, they will be creating a problem that they don’t even realize. People will respond to them with a gasp and that is not the reaction anyone wants from aesthetic procedures.
Meet the expert
Ava Shamban, MD
Dr. Shamban is a board certified dermatologist who believes that appearance and self-esteem are one and the same. She graduated magna cum laude from Harvard University and earned her medical degree from Case Western Reserve University School of Medicine. She is currently a member of the American Society for Dermatologic Surgery and the American Academy of Dermatology and serves on the editorial board for The Journal of Clinical and Aesthetic Dermatology. In addition to her practices in Santa Monica and Beverly Hills, Dr. Shamban is an assistant clinical professor of dermatology at the UCLA- Geffen School of Medicine, lectures internationally and serves as a principal investigator on many clinical and FDA trials. She is the author of Heal Your Skin: The Breakthrough Plan for Renewal, makes regular television appearances and is frequently quoted about health and beauty in magazines worldwide.
