At her Davie, FL practice, Precision Skin Institute, dermatologist Lesley Clark-Loeser, MD houses one of the largest arsenals of cutting-edge lasers and energy-based devices in the region, so it’s no wonder she has become the go-to for patients of all ages with all skin concerns. Here, she explains her in-office approach, as well as the top treatments for each age group to look and feel their best.
You’ve coined your in-office approach “Precise Aesthetic Balance.” What does this mean exactly?
Science and art are intricately woven in our approach to precision facial aesthetics. This is a nonsurgical approach to define, refine or restore facial balance, generate a refreshed look and optimize beauty. ‘Precise Aesthetic Balance’ addresses all of the changes that are happening in all of the layers of the face, from the most superficial layers of the skin through to the fat and even down to the bone, at the ages at which they are likely happening. In our 20 and 30s, the issues and needs we encounter are very different than for individuals in their 50s, 60s and older. We travel from prevention, prejuvenation and defining our aesthetic goals to refining, and lastly restoring the effects of photoaging, and simply aging. This can be a very overwhelming world when it comes to sifting through all of numerous products and procedures promising the fountain of youth. This is an attempt to simplify the daunting task of wondering which skin-care products you should use, and which treatments are best for you and how to plan for them.”
How do you guide a patient who wants to look refreshed but doesn’t know where to start?
“We start with an intake sheet and then work with the patient to personalize a plan that incorporates a combination of skin care, energy-based therapies, neuromodulators, hyaluronic acid fillers and/or biostimulators to treat the face as a whole and create the best version of the individual. It’s amazing to see someone feel their best without looking altered or unnatural—they just look good. When you look in the mirror and how you feel inside is reflecting back at you, that’s an incredible feeling—to have how you look and feel match a little bit more closely. I think that’s something that a lot of women search for, especially those who are just entering their 40s and you’re like, ‘Wait a second, what’s happening.’ I can relate so much because I’m almost leaving my 40s right now. I love helping my patients walk into their 50s feel more confident and more beautiful.”
What do you recommend for the 20s and 30s age group?
“Define: When we use the word ‘define’ for this group, it’s because at this time, we’re really defining our aesthetic goals. However, it can also apply to defining facial features you think you don’t naturally have, like thin lips. But really, it’s more of the world of prevention and prejuvenation, including everything from skin care and energy-based treatments to neuromodulators and/or fillers. Photoprotection with sunscreen and antioxidants are two important topical products to use, and very light chemical peels are a great way to promote cell turnover and impact excess pigment production. These can be nice for someone who is really wanting to enhance the quality of their skin, but not undergo something that has more downtime or cost. We also do a lot of Botox Cosmetic in the crow’s-feet and glabella, and we’re also starting to see a lot more demand for lip flips and lip enhancement. Clearly, there’s been a big social media influence on what’s considered the standard lip right now, and there’s a new lip ideal, so we have to be a bit careful in what we agree is ‘standard.’ I won’t personally do lip filler off-label on patients who are too young, typically younger than 22.
Refine: When you move into ‘refine,’ that takes on the assumption that more things have started to happen as you move down into the deeper layers of the skin. The best example of that is that once we hit 30, we know that collagen production is exceeded by destruction. We’re breaking down more than we’re producing, which can be addressed with collagen-induction techniques like microneedling or superficial radio-frequency treatments and lasers—even some topical products. Microneedling has become really popular in this age group, and it can be done in all skin types and tones, even sensitive skin and darker skin tones. Anything we can do to stir the pot and start stimulating collagen production is a good thing. In this stage, we also have changes to the surface of the skin like brown spots, melasma, etc.
Restore: There are some things that can be restorative in this group, like correcting acne scarring, but for the most part, this group is focused on defining and refining in a more superficial way.”
What do you recommend for the 40s and 50s age group?
“This is the group that basically tells me, ‘Bring it on’ because everything is starting to happen and you need to treat all layers of the skin: color, texture, tone, tightness, volume loss, beginning bone loss.
Define: We see consistent use of neuromodulators for sure, as well as replacement of lost volume, treatment of mild-to-moderate facial folds, and lip enhancement.
Refine: Energy-based devices are also still popular, but we take it a little bit further. Although we do microneedling—typically once or twice a year—we also do more aggressive radio-frequency like Profound. It’s a little bit more of an investment for patients—usually no less than $3,000 for a single treatment—but it’s a one-and-done, meaning a series of treatments isn’t needed. We start to do different types of fractionated CO2 resurfacing, we do a lot of Picoway as another way to induce collagen production with very little downtime, and we treat brown spots and vascular issues like rosacea with lasers.
Restore: Our facial skeleton starts to change during this time period and kind of shrinks backwards into our face, so we start to see marionette lines that make us look sad, eye bags, and nasolabial folds start to look a little deeper. That’s why it’s a great time to start treating and addressing these areas because it will result in the most natural-looking outcomes.”
What do you recommend for the 60-plus group?
“This groups build on the previous one with more advanced treatments. We start with correction.
Refine: I often recommend fractionated CO2 lasers and Profound to get their skin in the right place. Sometimes also adding Picoway or alexandrite lasers and IPL to treat pigment issues. It’s also never too late for neuromodulators and fillers.
Restore: And in this age group, we use a lot of biostimulators. I’ve been using a lot more hyperdilute Radiesse these days. We can treat the neck, face and décolleté, and combine with hyaluronic acid fillers, especially in the lips. We now have more options than ever before in our HA filler toolbox. It’s amazing how many women in this age group who are new to fillers point to their lips last—they point to every other place on their face—but the first place they really benefit is their lips. You can really, truly give change the face with something so simple, even less than one syringe. They’re like, ‘Oh my gosh, I can line my lips and wear lipstick again!’”
“I am grateful for the relationships that I enter into with these patients. Being their partner on this aesthetic journey gives me such joy and fulfillment.”