Sagging Cheeks and Sculptra, Thermage, Fraxel

QUESTION 1: I am in my mid/late 30s and have a thin face. I've noticed that the skin around my cheeks has lost collagen (not the lines around the nose...they are more around my mouth and cheeks when I smile. Lately they have started to sag a little).I have read articles on fraxel, but then read about thermage on your site -- which one is better for producting collagen? Will they really life the muscles around the mouth? QUESTION 4: I see you recommend several anti-oxidants. I would love to purchase one, but I want to make sure that I am getting one that is "stable". I read an article on Vitamin C creams at one point, and the article said it is very difficult to produce (and purchase) a Vitamin C cream that is stable, as the base chemical tends to decompose/break-down easily. The article said that this can actually damage your skin more than it helps it. After I read that, I tossed out all of my Vitamin C creams (they weren't any of the products you mentioned and b/c they were less expensive, I was worried they were not good). Is this true about Vitamin C? And, my big question: if we order this stuff online, is there a chance that the creams were exposed to temperature flucuations/heat that may have damaged the product?

Erica  – 

 On the first one, you don’t tell me your city, but if you live near someone who does a good job with Sculptra, that might be the best choice for someone with your facial type.  It builds collagen while adding volume.  Fraxel is better for brown spots, fine wrinkles, and improving texture but it doesn’t add volume.  Thermage is better for a little tightening all over.   Volume might be more helpful for you if loss of facial fat over time is the main problem.

 About stability of your vitamin C products, the main goal is air tight as much as possible and no exposure to light.  If it’s in a bottle, it should be tinted glass and keep it in a drawer.  The SkinMedica (you can buy this on SkinTour) Vitamin C Complex is good, as is the SkinCeuticals C & E Ferrulic, or the Cellex-C Vit C 20%.  There are other good ones. If you are easily irritated, you may need the help of a good dermatologist to find the right one.  Most companies who make these products ship to protect them, but you could order it 24 hours delivery if you are still concerned. 

Dr. Brandith Irwin, MD

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