A dermatologist's guide to anti-aging treatments: Botox, peptides, more

Dr. Elizabeth Hale, my dermatologist, has shared expert advice about melanoma and skin care do's and don'ts — and now she's bringing us answers to questions about a wide range of popular anti-aging treatments. 

With years of experience as one of the leading dermatologists in the country, Hale knows about everything from botulinum toxin injections (like Botox) and laser treatments to Intense Pulsed Light and various fillers — and can also fill us in on newer trends like peptides and more outlandish-sounding social media crazes like salmon sperm facials.

Here are some of her insights on procedures that could help you achieve healthy, natural- looking results — and which ones you may want to steer clear of.

Botox 101

Botulinum toxin injections, like Botox, are the most common minimally invasive cosmetic procedure performed in the United States, accounting for about half of the total.

Hale says she and her sister, also a dermatologist, perform that type of injection "every single day" at their dermatology practice, CompleteSkinMD.

Knowing how it works can help patients determine which of the various types may be right for them.

According to Hale, Botox "selectively weakens" muscles by stopping the release of acetylcholine, a neurotransmitter that controls facial movement. Muscles need acetylcholine to contract; if they can't contract, the appearance of lines reduces.

What intimidates some potential patients, though, is the fact that Botox is derived from botulinum toxin A — a toxic substance which, if mishandled, can lead to death. However, in a dermatological setting under the hand of a licensed professional, it is "quite safe and effective," Hale assures. Some of her patients visit multiple times a year to get touch-ups.

I have had my fair share of Botox injections and noticed that as time progresses, the injections do not last as long. This is a common experience. Hale recommends that patients allow for "a little movement" in their injection sites as they age to help keep the face looking natural.

Botox isn't just for forehead wrinkles. Crow's feet, crepey skin and frown lines are common issues dermatologists can address with Botox. Additionally, Botox is FDA approved to help people with hyperhidrosis (overactive sweat glands) and even migraines.

Is "baby Botox" worth the hype?

You might have heard about the "baby Botox" trend on social media as people try out a lighter use of injectables. "Baby Botox" works exactly like regular Botox treatments, only the dosage is less, with just a small amount used in the injections.

What is the appeal? Hale says small amounts of botulinum toxin "is somewhat preventative" and can prevent muscles "from forming those lines in the first place." 

The trend is popular with younger patients and celebrities who want to soften some of the lines in their face while still being able to show emotion. 

However, the caveat is, as Hale puts it, "The less [Botox] you use, the shorter it lasts." A patient would need to visit their dermatologist every one or two months, instead of four to six, to maintain the effects of baby Botox. Hale says the frequency may also reduce the efficacy in the long run. 

"There's some data that if you're doing these small mini injections," Hale said, "you might increase the chance of antibody formation and then it won't work as well." This is similar to how normal Botox injections may appear less effective as we age and the skin becomes used to the dosage.

Hale recommends people interested in baby Botox choose a regular dose and "let it wear off completely and do it again in four months, instead of coming in for these little baby injections."

What to do about crepey skin

Overexposure to the sun is the primary cause of skin damage and signs of aging. When the skin becomes visibly crepey, it is a sign the skin is dehydrated. 

Hale says, to reduce crepey skin, focus on "preventing … overexposure to the sun" and moisturizing in the morning and ideally with a retinol at night. The retinol will help with cell turnover as the skin repairs itself overnight.

For those experiencing a hormone imbalance or in menopause, she says incorporating topical hormone therapies with estrogen on more delicate parts of the skin, like the neck and under the eyes, can help restore the elasticity and strength of those areas.

Hale will also recommend for some patients a combination of "carefully done procedures" like Fraxel and fillers to help resurface the skin. She says microneedling has also been shown to be effective with certain fillers to tighten collagen in the skin and strengthen the skin's texture.

What to know about PDRN

Korean skin care has long been viewed as the gold standard in beauty and skin products. Hale agrees, saying, "Korea is often ahead of where we are in the States." 

But some trends might need a bit more research before you should take part.

PDRN is a form of salmon trout sperm that "is injected very commonly in Korea," Hale said, "and they sometimes do salmon sperm facials." The ingredient is reported to help "stimulate the body's stem cells," and proponents claim those cells help rebuild and rejuvenate the skin. 

Hale is not totally behind PDRN injections. Some who have received the treatment reported granulomas or nodules under the skin that occur when the body triggers a "foreign body reaction." 

Instead, she suggests those who are interested in PDRN should try the peels or topical formulas, "but don't have it injected."

Peptides and red laser therapy

Peptides and red laser therapy are also common, trendy skin care procedures often promoted on social media. 

While there is evidence that red light therapy can help "take inflammation out of the skin" and "can stimulate a little bit of collagen," Hale said, she believes the effects are not dramatic to the point where she would prescribe it as a cure-all for skin health.

In terms of peptides, Hale says there is not enough data yet to say whether the injections are beneficial for the skin. Peptides are the building blocks of proteins and thus the foundation of our skin, "so in theory, peptides make a lot of sense," Hale said. But until more research is done, she's not ready to get behind the trend.

Dr. Hale's favorite procedure

Hands down, Hale says, "Sculptra is my single favorite product, my single favorite procedure I perform" at CompleteSkinMD.

Sculptra is a type of biostimulatory filler that stimulates the body's natural collagen production process, leading to the gradual "restoring of lost volume" in the face. 

Hale was first introduced to Sculptra years ago as a faculty member at New York University. At the time, it was used primarily to help patients with AIDS suffering from the "facial wasting" that comes with the virus.

"It was really very meaningful because [Sculptra] really restored their quality of life," Hale recalled.

As medications to treat HIV and AIDS improved, Sculptra was no longer needed for those with the condition, but the field of cosmetic dermatology welcomed the filler for other uses.

"Especially now with people on the GLP-1," who would notice "they lost volume, and their temples are hollow, and their faces are flat" after using a weight-loss drug. Sculptra is Hale's preferred way to restore the fullness to their face and recommends it to her older clients as well.

"It is gradual. It's slow. It's ... supernatural," she said.

The value of consistency

The one thing Hale probably values most is the consistent practice of protecting, cleansing and moisturizing your skin. 

"Consistency is very important," she says. Applying a broad-spectrum sunscreen with an SPF of 30 or higher every day, along with washing and moisturizing your skin in the morning and evening, is the foundation of healthy, young-looking skin. Hale refuses to work with patients who won't commit to these skin care basics.

Looking young and healthy "shouldn't just be a quick fix," she noted. "It's really part of taking care of your skin every day."