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Aging Skin: Nature Does Not Trump Nurture

Have you used that app that shows you what you might look like as an old person? It can be a bit grotesque and downright scary. My advice? Don’t believe it.

People all age differently from one another, even within the same family. I have found this to be true not only in my practice, but there is consensus in the medical community as well. In an article in the New York Magazine’s The Cut,  plastic surgeon Dr. Dara Liotta talks about how your genes and ethnic makeup affect the way you age — everything from skin tone to the fat content of your skin, to the DNA that can keep you naturally babyfaced longer. Or not.

“Aging isn’t just about wrinkles,” say The Cut’s Kathleen Hou. “Most of us hear the word aging and think one thing: wrinkles. Or at most, two things: wrinkles and sagging skin.”  She goes on to say that the majority of people experience a combination of wrinkles, hyperpigmentation, loss of elasticity, and loss of volume (meaning the opposite of flatness), as they age. How much of that enters into our own equation might not be known until we see it happening. I have seen patients who swear they will age the way their mothers did (good or bad) only to find that their skin did not reflect the same combination of factors. “On top of that, the texture and color of your skin affect the likelihood of it exhibiting these characteristics,” say Hou. “With the march of time, elastin and collagen become looser (collagen even eventually stops being produced over time). Fat cells also start to shrink.”

Anyone ever tell you that you have thick skin? Consider it a compliment. The thicker skin, the slower the signs of aging.  I have a client nearing age 70 whose skin is so thick that  you’d swear she was a 45- year old. I treat her with Broadband Light (BBL) for hyperpigmentation, have given her Halo® treatments, and have done some Juvederm®  contouring, but I can’t find a place on her face that actually needs Botox as she approaches her seventh decade. Even her fine lines and wrinkles are hardly noticeable. Her Mediterranean roots have served her well, even though she does not possess olive skin.

If you have plump skin, consider yourself lucky. “In South Korea, the beauty ideal for skin is something called chok chok — a term that means ‘plump and moist,’” says Hou. Genetics have a role here as well, as some ethnic groups tend to have higher fat content in their skin.

Melanin is, of course, a huge factor in how your skin ages. It’s the pigment that gives your skin and hair its color.  While Dr. Liotta says lots of melanin offers a degree of UV protection, having melanin-rich skin doesn’t mean you can throw away the sun screen. It just means you (luckily) have some built in SPF as you age. Melanin-rich skin, however, has its own variety of issues. It tends to show aging by leaving you the gift of hyperpigmentation and sun spots. Dark spot correction can be addressed in my office and require BBL treatments that take place over a series of appointments. 

Then there is the part I can’t help with: “Nutrition, skin care, exercise, all still play a huge part — these are all things that help keep your skin and body from showing signs of molecular damage and being reparative to your DNA,” says Dr. Liotta in the article.  While we do tend to age like our mothers, it’s truly a combination of nature (genetics) and nurture (how we treat our bodies and faces) that come into play when evaluating how your skin might age.

The longer I am in practice, the more I am realizing, however, that a commitment to good skin care is like a commitment to anything else. People are not only living longer because of diet, exercise and having a sense of purpose. If they care about how their skin ages, they can be just as committed, using many of the tools I offer to keep them looking younger longer. BBL, Halo®, Juvederm, Botox®, and hydrofacials, when properly administered, can actually make you feel as if the clock is going backward.

There is no doubt about it: skin is in. Self care for skin and anti- aging are no longer smoky buzzwords; they are realities.  I am not a fan of the “boutique” med spa experience — a quick in-and-out appointment with a practitioner simply doing what a patient has ordered up. My practice is built on the amount of  care taken to explain not only what is being done, but also to explain to you how it will age as we go forward. I see myself as a partner in your health and beauty care, with a solid commitment to giving you all the time as well as the education you need to make wise anti-aging decisions. 

Getting to real reason OptimalU exists: I care about how your skin ages

I am often asked how I became so passionate about skin care and aging. So I thought I would outline the information I gathered before I even thought of opening my practice as well as educate you a bit on one of the anti-aging technologies I embrace. Research into anti-aging skin care at one point became a huge focus for me, so I encourage you to read on.

First of all, you may not realize the largest organ of your body is your skin. We tend to take for granted that which holds everything in is just there — keeping our organs from falling out or being exposed. Skin can be one of the most neglected organs, not considered a part of overall health maintenance as we age.  Yet skin can speak volumes about us to others as well as to what we see in the mirror.  Our skin often reveals our age as well as provides clues to our overall health status. It’s almost instantly evident when I see a new client if they have experienced too much sun exposure, became challenged with acne scarring, possesses unbalanced hormones, or simply has not looked after this gigantic body organ. Sadly, even patients as young as their 30s and 40s have come in to my office with wrinkles and skin discoloration — early signs of aging.  

My practice and aging skin …

The beginning signs of aging skin are subtle at first.  Wrinkles start to show mostly with expression lines around the eyes and forehead.  Then these wrinkles become static wrinkles in the skin.  Skin color becomes dull. Pores enlarge. And loss of collagen promotes skin laxity.  At first this seems like a cosmetic inconvenience.  However, aging skin also means a decrease in skin cell turnover and in some individuals this will lead to skin cancer.  This is one of the reasons skin cancer rises dramatically in individuals over the age of 50.   Well into midlife skin cell turnover significantly declines.  So slowing the aging process is not simply a cosmetic issue — it’s a real health concern. Studying this aspect of skin health is what got me the most interested in opening my med spa. As many of you know, I will perform procedures on my patients if — and only if — I believe that procedure will aid in the appearance of aging as the years progress. That means I often turn down those who come to me for purely cosmetic reasons if I see their request as something that will not serve their skin in the long run. There are plenty of practitioners out there who are happy to accommodate them and have different philosophies from my own.

The research behind what I do…

In the past, patients were told to stay healthy by eating a good diet, stop smoking, watch the  alcohol intake, get sleep, and actively manage stress — activities that result in youth maintenance on the inside. These habits promote healthy DNA in all cells of the body.  Unfortunately, there were few options to rejuvenate the skin and reverse the aging process going on on the outside.  In 2000, a Stanford professor Dr. Anne Chang was studying the genes responsible for aging.  She researched why skin grows old and discovered that more than 2000 genes were responsible for the overall aging process of the skin.  Another Stanford professor, Dr. Patrick Bitter Jr., was inventing a device for cosmetic improvements of the skin.  The FDA had had already approved the device for treating redness such as rosacea and abnormal skin pigment or age spots.  This  broad band light device, called BBL, was successfully shown to brighten and tighten the skin on the face.  However in the early 2000s, Dr. Bitter had yet to discover why the device produced such great skin results. 

After attending a medical lecture given by Dr. Chang, Dr. Bitter suggested a collaboration with her.  That collaboration resulted in the a medical study from the Stanford University indicating the BBL device made by Sciton® restored the activity levels of about 1,300 of the 2,300 age-related and damaged genes of older women’s skin.  This study was a break-through moment, with the medical community saying, “Gene Expression of aged skin more closely resemble young skin with the use of Sciton Broad Band Light treatment.”  Other studies from Stanford have been published and validate this claim.  DNA from patients has been sequenced and indicates an increase in skin cell activity with BBL treatments.  Finally. A way to rejuvenate the skin and partially reverse the aging process at the DNA level.  The BBL device is now referred to as the “Forever Young BBL” as patients who routinely get treatments appear to defy the skin aging process.  The BBL is great for patients of light to medium skin tone who wish to maintain younger looking skin. 


When all is said and done, you’ve got YOU under your skin …

If you are fortunate enough to have young, healthy looking skin, start a skin health care plan now.  Good skin care products including sunscreen and a targeted method of encouraging skin cell turnover will provide beautiful skin as you age.  My advice? Don’t wait to begin treating your constantly-aging skin. Start now and you’ll be ahead of the game. Just as you know diet and exercise can keep feeling better and moving like a younger version of yourself, so do treatments like BBL. Feel free to call me at  916.886.0220 for a consultation to see if you are a candidate.

~Dr. Andrea Tse

Hyperpigmentation: a long word for skin damage …

Throughout our lives our skin takes a beating. Whether skin discoloration occurred from too much exposure to the sun, remnants of teenage acne scarring, unbalanced hormones or just not taking care of it, skin discoloration or pigmentation is an issue most individuals will encounter during their lifetime. 

Cosmetic companies have our numbers. They make a fortune selling products to even out skin tone. And because we prefer not to have people focus on our blotchy faces, we buy their products eagerly. What much of the public doesn’t know, however, is that skin discoloration does not have to occur.  Prevention starting at the earliest age possible is the key to keeping young, glowing skin. 

Skin pigmentation simply means skin color in all its glory. That can mean patches of dark skin where even skin tone used to appear, most of which comes from the body producing melanin, which is the substance inherent in our skin at birth.  Melanin production can also occur when the skin cells respond to an inflammatory process to protect the DNA of your skin.  A perfect example is sun exposure.  In fact, sun exposure is the leading cause of abnormal skin pigmentation.  When melanin is produced as a form of skin protection, the pigment can be spotty or appear in patches. The result? Abnormal skin color and texture. Did you know that a suntan is actually a form of skin damage and there IS NO SUCH THING as a “healthy tan?” Those who were born in the era where they encouraged the sun with a bottle of baby oil laced with iodine will be the first to admit that they were ignorant as to the damage they were inflicting. And that a deep tan each year, while considered attractive at the time, served as a ticking time bomb as they aged.

So let’s get back to basics. Why is the skin of a toddler so perfect? With no wrinkles and no sun exposure, the skin has a glow and brightness as a result of perfect, even skin pigmentation.  No melanin has yet been triggered and in our youth our skin is rapidly producing new skin cells to replace the few that were damaged.  Fast forward to the teenage years and skin is starting to become uneven, no doubt by significant sun exposure and biological hormones as well. 

Now we are in our midlife. Decades of sun exposure, hormonal influences from pregnancy and/ or menopause, and/ or pharmaceutical medications like antibiotics have taken their toll.  By our 40s our skin cell turnover has declined, decreasing more with each passing year.  Age spots begin to appear because our skin can no longer combat the years of accumulated skin insults. Ever notice how you can see a difference in the age spots and even wrinkles on the left side of your face compared to the right side? It’s probably because the sun hit you on that side while driving your car.

What can be done now?

  • First and foremost, sunblock every day.  And I don’t mean relying on the spf factor in your foundation or moisturizer, I mean a real stand-alone sunblock of 30 spf or higher. 
  • Secondly, the products you use can be considered your skin’s diet.  Rejuvenating serums can be used to ensure the skin has all the materials necessary for healthy skin production and slow the aging process.  Products with vitamin C and E also help to combat skin cell inflammation and significantly reduce the formation of abnormal skin pigment. Remember that the skin is the largest organ in your body and maintenance is a crucial factor.
  • Lastly, encourage skin cell turnover.  There are many ways to do this depending on your budget and skin types.  Peels, hydrafacials, photofacials, and lasers can help increase cell turnover and treat abnormal skin pigmentation to turn back the clock for that healthy skin glow.

If you are fortunate enough to have been spared skin discoloration on your face, start a skin health care plan now.  Skin care products and a targeted method of encouraging skin cell turnover will provide beautiful skin well into your senior years.  Do not wait to care for your skin until abnormal pigmentation occurs.  This is a signal that significant skin damage is present.  Prevention is better than a cure when it comes to having beautiful skin and defying your age.

Call me for a skin consultation to discuss putting a slowdown on the aging clock and to even out your skin tone. It’s about repair and protection. I really do care. Focusing on your skin is my biggest priority.

~Dr. Andrea Tse

Self care without the guilt: look better, feel better

It’s a given. Watching your diet and exercising promotes good health, especially as you age. So how is beauty care so radically different? We work hard to take care of our insides as well as our bodies, but is paying attention to your looks such a narcissistic endeavor?

Med spa doctors and plastic surgeons get women and men of many ages through their doors. Some are trying to fix something that has bothered them, some are worried about how age is treating them, and others are just on a tear to look as gorgeous as they can be. And we enjoy addressing all of it. Some patients will not breathe a word about having come to us, as if spending money on themselves is the ultimate in self-centeredness. Many practitioners like me will admit that it’s rare their patients will even permit them to use before-and-after photos of them with their eyes blocked out and their identities hidden to show others how their treatments work. In other words, beauty care tends to be a deep, dark secret except, perhaps, between BFFs. 

While I understand this need to keep beauty care private, I also don’t see the need for shame. If you remodeled parts of your house or got your car repainted it would be no big deal. How are your looks any less something you own and keep up? In reality it just makes you feel better about yourself, so how on earth is this a bad thing? In her “(R)aging with Grace” article, Beauty Care: Feeling Good About Your Looks Past Age 60 writer Dena Kouremetis gets into the meat of it. “I often hear resignation from my age 60+ peers about keeping up with beauty care, but when I think about the alternative, it just sounds unacceptable in my world of one,” says Kouremetis. “So I began looking for the advantages to beauty care past age 60 and found that it’s not uncommon to be shamed by others about wearing makeup and/or appreciating it. She quotes a psychologist who argues that activities that allow us to take care of our personal beauty needs should not be viewed as “guilty pleasures.”

We have been carefully taught to suppress our interest in our looks, especially as we age, as if aging is a lost cause. In fact as many (women, in particular) age, they stop wearing makeup or doing skin care, accepting whatever nature hands them. And that’s fine. It’s a free country. But to put down others because they enjoy trying to look fresher and younger? That’s just not right. There are no absolutes where self-esteem is at stake. When you feel great about how you look, you have a better outlook on just about everything.

Morgan Shanahan’s Babble article I Got Botox and Didn’t Tell my Husband tells the story of a woman’s guilty pleasure. While she wanted to get rid of a wild eyebrow that had bothered her all her life, she failed to tell husband, Scott, that she was going to get Botoxed. “Three days later I woke up to discover I had no movement in my forehead whatsoever. It looked pretty good, but HO-LY was it a weird experience. My first reaction was to run in to Scott and make him poke my forehead and watch me try to raise my crazy eyebrow. But I couldn’t. Because I’d lied by omission and I was in it to win it now.” She goes on to say that about 6 months later she admitted it to him at a party.  “The thing is, my husband does think I’m beautiful no matter what. He also never noticed that I had frozen a quarter of my face. But now that he does know, our trust has been damaged. He can’t believe I would have gone and done something like that without telling him, and honestly … neither can I.”  While Shanahan loves what the injections did for her, the penchant to keep it a secret took a toll in this case.

While self-care is now a popular topic, many women find it necessary to justify spending money on beauty. One of my clients told me that each beauty product or procedure she spent money on began to feel like a small victory after years of feeling guilty about it.  She also told me that this was quickly followed by remorse and then another round of justification. When she discovered what she purchased actually worked, however, there was euphoria. This is a cycle that repeats itself, but there is no reason she should continue to suffer from it.  We have one time to go around, and there is no reason to think that an investment in your looks is not a prudent one.

Kouremetis said it best: “Having dominion over my looks means have a sense of control over something.  The concentration with which I apply eyeliner is unmatched and when I’m done with my going-out preparation I feel more confident to face the world.”

Anti-Aging Options Beyond Filler and Botox

“Nature gives you the face you have at 20.  It’s up to you to merit the face you have at 50.” 

Coco Chanel was ahead of her time when she uttered this, and never was it truer than today, when combinations of treatments and good skin care make youthful-looking skin last longer than ever. There is no better time in history to have birthdays than now, with anti-aging treatments capable of producing more extraordinary results than we ever thought possible. 

With all these anti-aging options available to you, where do you start?  Do you choose botox, filler, or skin treatments?  As a medical professional who has studied these treatments and their results in earnest, the answer is all of these choices.  While each category fills a different need, all work in harmony to minimize wrinkles, add volume in the cheeks and lips, and give you glowing skin.

Botox rules. It is the number one anti-aging aesthetic choice, providing a safe, reliable result when used properly. (We will explain “properly” in a moment.) No other product delivers such immediate results for wrinkle improvement than botox.  The optimal places for anti-wrinkle treatments with botox are crows’ feet (wrinkles around the eyes), “eleven” lines (wrinkles between the brows), and fine forehead lines.  While treatments for these areas are easily treated, forehead treatments can be a bit trickier. It’s important that your practitioner correctly balance both the anti-wrinkle result as well as the brow position or you may find your botox treatments causing unintended results.  Aggressive treatments with botox in the forehead can result in brow lowering, abnormal elevation of the brow, or uneven brows.  None of these results add to your anti-aging efforts and may even have the opposite effect — making you look “overdone.” Bottom line?  Botox in the forehead is best done conservatively.  Understanding the goals and limitations of botox is the first step in achieving an optimal result.   

Fillers came along as an alternative to botox, but are equally important — another product that can achieve that immediate anti-aging result.  Filler is a great option to add volume to the areas of the face that have decreased over time.  Using it in the cheeks and lip areas can create amazing results, creating the youthful look of a full face.  Nasolabial folds (upper mouth fold) and marionette lines (lower mouth wrinkles) can be filled as well, but should be considered only after the cheeks and lips have been appropriately evaluated.  Filling the nasolabial folds and marionette lines will raise folds and can create a somewhat unnatural upward smile (we’re sure the “Joker” Jack Nicholson look is not what you have in mind).  If budget is not a concern, I recommend filling all these areas, with cheeks and lips being addressed first.  Full cheeks and lips offer a youthful and sultry look. If you’re worried about lip injections, don’t. When performed properly (there is that word again) as an anti-aging technique, lip injections simply remove wrinkles and create natural looking fullness.

Somehow I think that if photofacials and lasers were available when Coco Chanel was in her 30s or 40s she would have looked even more amazing.  These are the anti-aging game changer.  Glowing skin with improvement in collagen and elastin has never been easier, safer, and taken less downtime.  The younger you start the treatments, the better your skin looks as you age, as if it resides in some form of  (happily) arrested development.  Photofacials and laser treatments promote the building of collagen and elastin which decrease wrinkles in the skin.  In addition, the devices I use promote a smoother skin texture and evens out pigmentation.  Our office uses the Sciton photofacial and laser device.  This brand is often referred to as the “luxury line” of laser machines.  Sciton’s motto of “because results matter” means what it says.  Not all devices are equal. Choose carefully and wisely to avoid a poor outcome or complication.  Scarring and burns can occur if a photofacial/laser is used poorly or aggressively. My advice is to choose Sciton or simply research the device you plan to have used on you before making a final decision.

Consider botox, filler, photofacials and lasers in combination to maximize your anti-aging regimen.  The goal is to use all these products in reasonable measure to achieve the kind of  outcome that will have you smiling and everyone else asking why you look so good!

~Dr. Andrea Tse

The photofacial: reinventing your skin

I know nobody likes the way skin responds to aging. Did you know that skin cells rejuvenate every 27 days during the youthful years? As we age, however, this rejuvenation naturally slows. It’s just part of life.

Eventually everyone experiences fine lines and decreased skin tone or even worse — heavy wrinkles — some by their 30s. How the skin ages is a combination of genetics, sun exposure, and sugar intake. In the past, the only modifying factors were sun exposure and diet.

The dangers of sun exposure and tanning are no secret any more, believed to be responsible for up to 90% of the visible changes attributed to aging. But did you know a diet high in sugar can slow down skin cell turnover? Sugar in the diet causes glycation. This is a scientific term for a process where high sugar intake leads to inhibition of DNA proteins and lipids. This leads to the slowing of the skin cell turnover process. The result? Dull, uneven skin tone.

The BIG news is that skin genetics can now be modified. In the past if your mother and/or father gave you the gift of inheriting heavy wrinkles at an early age, there was no solution other than an early face lift. Sciton’s Forever Young BBL treatment has revolutionized the way skin ages by changing skin genetics. This photofacial has been shown to modify DNA at the cellular level in several medical studies conducted at Stanford University. The studies concluded that BBL treatments promoted the gene expression of younger skin in older women treated with three sessions of BBL. When the DNA of middle aged women treated was sequenced, the DNA matched the sequencing and function of women 5-10 years younger. Finally — a modifiable option for skin genetics.

Maintaining your skin health with proper skin care to ensure skin health and vitality is essential to avoiding visible signs of aging. I personally have watched the rosacea and texture of my own skin improve with BBL treatments and I refuse to be sad about getting older. (Besides, everyone knows the only way to avoid getting older is to die young and I have no intention of doing that.) Instead I will out-smart aging by continuing to have gold standard anti-aging treatments on board.

For more information on BBL treatments and how effective it can be, call OptimalU at (916) 886-0220 or email us through this web site, optimaluclinic.com. I care about YOUR skin — not just how it looks now, but how it can look in the future as well!

~ Dr. Andrea Tse

An introduction: a new year, a new blog!



Starting this blog is an opportunity to inspire and inform about beauty, about aging well, and about my passion to make a difference in people’s lives. My goal is to provide education and insight gleaned through experience, research, and personal knowledge.  My hope, however, is that you will find the blog a source of information to age well and beautifully the same time. 

I became a doctor  with the goal of fighting disease. Over the past 14 years I have been an anesthesiologist, helping to care for people while a surgical cure to a disease they possessed was taking place.  During this time period it became clear that many patients lacked insight into understanding how individual choices were contributing to their disease, all contributing to their aging poorly.   After being involved in a few hospital wellness projects for patients, I began to develop a new understanding of just what the word “wellness” meant.  I realize now that wellness is made up of a number of elements that contribute to a person’s lifestyle, not the least of which is their appearance.  Some of my clients began requesting Botox, citing my gentle touch with needles during procedures. Initially I begrudgingly obliged.  To my surprise, however, the patients who received these beauty treatments seemed more motivated to be or stay healthy to match their improved appearance.  It was as if seeing a person in the mirror who began looking 5 to 10 years younger provided a higher level of commitment to stay healthy. 

Botox has evolved to become a surprisingly simple and safe way to appear younger. So after treating a few clients with it, I was asked about administering other aesthetic options as well.  Looking for med spas around the greater Sacramento area to refer these clients to for more services, I noticed that there weren’t any aesthetic clinics with a focus on anti-aging and wellness.  Many offered opportunities to grasp at youth, but the aesthetic websites did not emphasize basic well-aging techniques.

When I set up OptimalU, my goal was to be different and to reassure my clients and potential clients that they are in good hands. Instead of focusing on dollar volume, I wanted to offer treatments I knew would stand the test of time.  OptimalU employs a multi-modality approach — something I will explain more about in later posts here. Suffice it to say, I believe treatments and injections may not be the best way to go unless both the patient and I can clearly see a long term benefit to them.  Client photos are used clinically — kept on file to demonstrate the progress being made.  Reviewing these photos showing how an individual’s appearance has improved over time is one of my favorite parts of the entire process.

I hope to post often to this blog, but will consider talking about any topic of interest to you. Please don’t hesitate to ask!  I look forward to being your personal beauty/well-aging expert (they go hand in hand!). My biggest reward is the great feeling you have about yourself when you look in the mirror. And to all those who have already referred friends and family after their own experiences at OptimalU, a hearty thank you and Happy 2019!

~Dr. Andrea Tse

MEET ANDREA TSE, M.D.

Dr. Andrea Tse is a board certified physician who focuses on the total person.

She offers the finest anti-aging laser treatments by Sciton, proven to provide anti-aging benefits at the skin's deepest levels. Dr. Tse also performs several non-surgical procedures to tighten, brighten, and make the skin look like it did years ago. Her specialized aesthetic training as well as her artistry combine to assure the most beautiful results.

Dr. Tse is also a passionate proponent of physician-grade supplementation to restore the body and, simply stated, make life better.

She provides her patients even more—a compassionate ear and a true partnership. Her patients know they are both cared for and cared about.

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