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2015 ASDS Consumer Survey on Cosmetic Dermatologic Procedures
Expertise and Training
Dermatologist, Dermatalogic Surgery
Current Philosophy of Dr. Shelton in Facial RejuvenationDr. Ron Shelton, who has, unlike many dermatologists, undergone additional training as a fellowship in cosmetic dermatologic surgery, has seen many changes in the practice of facial rejuvenation amongst dermatologic and plastic surgeons since he established his practice in 1993.
Many times facelifts are needed to correct significantly sagging skin and jowl formation as well as lowering of the upper eyelids with excess skin “hooding”, however this removal of excess skin and tightening should be done so that the skin is pulled in what appears to be a natural appearance and not so far behind on the face that “drapery” horizontal pleats form on the lower cheek. When facelifts are done expertly and artistically providing natural appearances, there is often a volume deficiency that needs to be corrected in the mid cheek and other areas of the face such as the temples, smile folds, outer chin (marionette lines) folds, etc.
It is this area of volume atrophy, usually caused by fat loss with age and diet/exercise, and sometimes with medication prescribed for immune deficiency, that create an aged appearance and sickly appearance. Facelifts only lift. This procedure does not replenish what is lost as the volume diminishes in the mid cheek. A beautiful aesthetic rejuvenation is accomplished by improving this sunken-in appearance which can also help support the sagging skin. Knowing where to inject the filler, in which plane, or depth, which filler is best for that specific depth, and to know how to layer different fillers of different viscosities (densities) is part of the art and science of facial rejuvenation. There are so many fillers these days including, but not limited to: Juvederm, Restylane, Belotero, Voluma, Radiesse, Fat Injections, Sculptra and others.
There are some patients who have realized that they may need a facelift years-to-come but want to stall this time as long as possible and to start doing treatments that will PRESERVE or REFRESH their appearance. This is what appeals most to Dr. Ron Shelton. New patients seen in consultation are given the opportunity to express what bothers them about their appearance, or what they like and want to maintain despite what they see having happened to their parent who looked so much like them years ago.
The big picture is formulated only after listening carefully to his patient’s concerns and then analyzing their faces carefully. Dr. Shelton then breaks it down in terms of the aged appearance and whether it involves, surface texture and color, dermal, or infrastructure, damage such as wrinkles and deeper tissue atrophy such as fat wasting which ruins the infrastructure.
The surface can be improved with topical antioxidants, such as ergothioneine, vitamin C, vitamin A, and preserved with the appropriate sunscreen for that patient’s skin.
The dermis can be improved with topical ergothioneine, retinoic acid, Fractional laser resurfacing such as Fraxel Dual or Repair, chemical peels, dermabrasion and non-invasive tightening devices such as ThermiSmooth, Pelleve, Thermage, and Ultherapy.
Actual skin tightening can be accomplished with a technique that is in-between non-invasive therapies and surgery. ThermiTight is a procedure unique in this category and helps tighten sagging skin with injectable radiofrequency energy. There is down time related to this procedure which involves at least swelling, but may also involve bruising. The temperature achieved in the dermis and subcutaneous tissues is much greater with this device than any other no-downtime procedure, so there may be better tightening and lifting although the downtime of swelling is usually more.
Dr. Shelton listens carefully to his patients and their lifestyle, including their social and work history. He then creates an aesthetic plan that can work with his patient’s life.