Aging Skin and Anti-Aging Treatments
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Before & After PhotosAging Skin and Anti-Aging Treatments



The goals of skin rejuvenation and anti-aging treatments

Over the last few years, the cosmetic medical treatment trends have been moving away from surgical skin-tightening procedures, like facelifts, to minimally invasive skin rejuvenation.  These minimally invasive procedures are focused on improving, reversing and delaying the visible signs of aging with little to no downtime. 
Aging Skin and Anti-Aging Treatments

The formula is simple:  The Four R’s

  • Repair damage resulting from sun exposure, smoking, pollutants
  • Restore – increase hydration, firmness, smoothness and fullness of the skin
  • Renew – increase epidermal cell turnover and collagen production
  • Rejuvenate the skin’s appearance


A thorough understanding of the large and small scale changes associated with aging is necessary in any attempt to restore the beautiful, radiant, youthful appearance.  At Summit Medical Group we offer a variety of rejuvenating procedures to help delay and reverse the visible signs of aging. 
We combine the volumizing effects of dermal fillers with wrinkle relaxers and laser skin treatments to circumvent the need for more aggressive plastic surgery.  Patients are able to return to work the next day with some immediate results and see continued improvement in skin tone and firmness for the next several months.

A consultation is recommended to determine the best choice for your cosmetic goals.  Call us to learn how you can safely and effectively restore volume and fullness in skin, lips and hands – with minimal downtime!  (908) 277-8668.

What are the aging changes in the skin?

  • Skin becomes more transparent and pale due to thinning of the outer skin layer (epidermis).
  • The uppermost part of the epidermis (cornified layer) becomes thickened and dehydrated, leading to a dry, scaly appearance.
  • Large pigmented spots (age spots, brown spots, freckles) appear in sun-exposed areas due to excess melanin production.
  • Skin’s strength and elasticity decrease due to decreased production and increased breakdown in collagen and elastin. The skin becomes leathery and weather-beaten in appearance.
  • Blood vessels become more visible and more fragile due to thinning of the dermis, giving rise to visible facial veins, diffuse redness, spider angiomas and easy bruising.
  • Oil production decreases, resulting in dryness and irritation.
  • The subcutaneous fat layer thins and redistributes


What are the visible signs of aging? Deflation vs. descent

Skin changes are among the most visible signs of aging.  Skin aging first becomes apparent when the person is in their 30s with the development of subtle changes, such as fine expression lines around the eyes and mouth and deepening of the tear trough, giving the face a somewhat tired appearance.
Aging changes progress in the 40s, 50s and beyond, with appearance of:

  • Deeper and more permanent lines of facial expression that do not disappear when the face is relaxed
    • Crows feet
    • Frown lines
    • Smile lines
    • Forehead lines
  • Loss of skin firmness and tone
  • Thinning lips with downturned, deepening corners
  • Sunken cheeks
  • Appearance of jowls
  • Loose, sagging skin of the lower face and neck
  • Drooping eyebrows and eyelids
  • Sallow, dry, rough skin
  • Skin thinning with appearance of dilated blood vessels and spider veins
  • More noticeable, larger pores
  • Age spots, seborrheic keratoses and uneven pigmentation


Aging Skin and Anti-Aging TreatmentsPreviously it was thought that wrinkles, folds and skin sagging develop due to gravity pulling the skin down. What we know now is that it is not the stretching and drooping of the skin that accounts for the wrinkles and folds we see as we get older.

The most significant contribution to the aged appearance is loss of volume in the skin, soft tissues, fat and bone that creates the visible signs of aging.  Aging changes are more like a deflating balloon than a descent due to the action of gravity.  Volume loss leads to the shifts in facial shape, balance and proportions.
We can visualize this by looking at the difference between grapes and raisins.

What are the characteristics of a youthful vs. aged face?

Aging Skin and Anti-Aging TreatmentsWhen we look at faces, we automatically focus on the center triangle in the middle of the face, including the eyes and nose.  Everything else on the face is a combination of light and shadows. The biggest difference between young and old faces is the amount of volume in the skin, soft tissues, fat and bone.
A young face has ample volume, creating smooth, full, soft arcs and curves in the brows, temples, cheeks and jawline.  These uninterrupted curves and arcs reflect light.  How the face reflects light gives us an idea of how old that face is1.

In a youthful face, light is reflected from a number of surfaces:

  • Brows
  • Back of the nose
  • Cheekbones
  • Upper lip
  • Chin
  • Earlobes


With loss of volume, the smooth curves of the face flatten, giving rise to hills and valleys and eventually shadows where only light reflection used to be.  Increased laxity of the skin combined with loss of its supporting structures (soft tissue, fat and bone) lead to sagging and appearance of nasolabial folds, marionette lines and jowls.

Aging Skin and Anti-Aging Treatments

This loss of volume is seen in:

  • Dermal thinning with loss of collagen and elastin, the fibrous network that gives the skin firmness and elasticity
    • There is slowed formation of new collagen and elastin fibers
    • Sun damage activates enzymes that break down existing collagen and elastin fibers.
    • Decreased support of the dermal blood vessels leads to the appearance of facial veins and easy bruising.
    • Skin becomes thinner, more fragile and more easily damaged.
  • Fat loss and redistribution under the skin
    • The seven fat compartments of the face decrease in size and separate from one another, creating valleys and shadows instead of smooth arcs
  • Skeletal remodeling with loss of bone from the brows, cheekbones, around the nose, the chin and jawline


What is photoaging? Intrinsic vs. extrinsic aging

Aging Skin and Anti-Aging TreatmentsThere are two components of aging changes in the skin:


  • Intrinsic or chronological aging
    • Occurs in both exposed and non- exposed areas of the skin
    • Caused by internal physiological factors alone
    • Regulated by the person’s genes and defective repair of the skin
    • Skin laxity and thinning, but retention of normal pigmentation and no actinic damage
  • Extrinsic, also called photoaging
    • Occurs on exposed skin
    • Caused by external factors, such as ultraviolet light, air pollution and smoking
    • Sun damage due to ultraviolet light is responsible for almost 80% of the skin changes commonly attributed to the aging process2.
      • The most important anti-aging procedure is sun avoidance and the use of broad-spectrum sunscreens and sun-protective clothing every day!
    • UV damage reduces formation of new collagen and increases the destruction of existing collagen in the skin.
    • UV damage produces tiny wounds in the skin, that accumulate and become visible in the skin as wrinkles, irregular pigmentation and a dry, leathery appearance.


Glogau classification of photoaging3

The clinical signs of skin photoaging include changes in color, surface texture and function of the skin.  These changes are graded from minimal to severe photoaging.

  • Visible color changes include:
  • uneven pigmentation
  • increased skin transparency
  • brown spots or age spots
  • sallow color with loss of normal pink glow
  • dilated blood vessel
  • Textural changes include:
  • roughness and coarseness of the skin
  • keratoses, benign and premalignant
  • progression from fine wrinkles to deeper lines, folds and creases
  • thinning of all three compartments of the skin: epidermis, dermis and subcutaneous fat
  • increased pore size
  • Functional changes include:
  • loss of elasticity with sagging and drooping of the skin
  • increased fragility and delayed healing after injury
  • increased dryness and irritability due to a faulty barrier between the skin and the environment


The Glogau classification system was developed to objectively measure the severity of photoaging and especially wrinkles. It helps us pick the best procedures to treat photoaging.

Glogau Classification of Photoaging




Typical Age


Skin Characteristics




No wrinkles

Early Photoaging: mild pigment changes, no keratosis, minimal wrinkles, minimal or no makeup




Wrinkles in motion

Early to Moderate Photoaging: Early brown spots visible, keratosis palpable but not visible, parallel smile lines begin to appear, wears some foundation




Wrinkles at rest

Advanced Photoaging: Obvious discolorations, visible capillaries (telangiectasias), visible keratosis, wears heavier foundation always




Only wrinkles

Severe Photoaging: Yellow-gray skin color, prior skin malignancies, wrinkles throughout - no normal skin, cannot wear makeup because it cakes and cracks


Procedures and skin care to help reduce and reverse the visible signs of skin aging

We cover the rejuvenation procedures for the specific areas of the skin in more detail in our sections on Facial Rejuvenation, Neck Rejuvenation and Hand Rejuvenation.

Botulinum Toxins:  Botox® Cosmetic and Dysport®

Botulinum toxins have become a key component in facial and neck rejuvenation. Usually it is the first cosmetic procedure performed to help treat dynamic wrinkles, which are some of the earliest signs of aging skin.

Botox® Cosmetic and Dysport® are excellent treatments for:

  • Frown lines (between your brows)
  • Worry lines (on the forehead)
  • Drooping eyebrows
  • Crows feet
  • Smile lines
  • Drooping lip corners, lines around the mouth
  • Horizontal and vertical neck lines


*Some procedures are off-label usages of FDA-approved products.

Botulinum toxins also work well in conjunction with other treatments.  By relaxing the muscles of facial expression, Botox injections help increase the lifespan of dermal fillers and rejuvenating laser procedures.

Dermal Fillers: Juvederm®, Restylane®, Perlane®, Radiesse® and Sculptra®

Dermal fillers are used to replace volume and fill creases and wrinkles, to help restore a more youthful appearance. Dermal fillers act by adding substance, increasing hydration and stimulating the skin’s own new collagen production.

Dermal fillers are ideal for:

  • Folds and wrinkles of the face
  • Dark circles under eyes
  • Accenting and plumping lip size (lip enhancement/lip augmentation)
  • Smoothing vertical lip lines (smoker’s lines/wrinkles around the mouth)
  • Facial scars from acne or injury
  • Nonsurgical nose reshaping
  • Facial sculpting and volume restoration
  • Nasolabial folds (upper and lower laugh lines) and frown lines
  • Depressed corners of the mouth
  • Marionette lines
  • Augmentation of cheek bones, chin or bridge of the nose
  • Aging hands


Laser and Intense Pulsed Light Rejuvenation

We now demand rejuvenating procedures that deliver the desired results and are at the same time without downtime and with minimal adverse effects.
In response to this need, over the last few years there has been a development of a multitude of laser and light treatment devices that accomplish exactly that.


  • Photorejuvenation with Broad Band Light (IPL/BBL/Photofacials)
    • Improves skin texture, wrinkles and photodamage while preserving the upper layers of the skin (epidermis).
    • Excellent at fading telangiectasias, redness, age spots, brown discoloration and other sun-induced pigmentary changes
    • Stimulates collagen production and remodeling with less discomfort and little or no healing time
  • MicroLaserPeel (Weekend Peel)
  • Precisely-controlled minimal to full epidermal laser peel removes the outermost layers of the skin, quickly improving the signs of aging with little downtime.
  • Ideal for sun damage, fine wrinkles, mild scars, age spots, poor skin texture and tone and pigment irregularities
  • Stimulates your own natural collagen production.


  • Fractional Laser Skin Resurfacing
    • Heats and vaporizes tiny cylindrical portions of the skin (epidermis and dermis), treating approximately 5-20% of the skin surface in one session
    • Excellent choice for removing sun damaged skin, discolorations, wrinkles, fine lines and moderate to severe acne scarring
    • Because only a small portion of the skin is removed at one time, fractional resurfacing results in faster recovery and fewer side effects
    • Causes an immediate contraction of existing collagen and stimulates new collagen production in the deeper layers of the skin
  • Skin Tightening with SkinTyteTM
    • Safe and effective procedure that delivers gentle pulses of heat deep into the skin, causing some immediate collagen contraction and triggering new collagen production
    • Produces a firming and tightening effect to improve skin’s strength and resilience


Cosmeceuticals and Anti-Aging Skin Care

At Summit Medical Group, we offer prescription skin care lines. 

These skin care preparations, along with retinoids and sun protection help accomplish the following:

  • Improve cellular skin function
  • Minimize the signs of premature aging
  • Reduce future photodamage
  • Help skin look and act younger and healthier




  • Rebecca Fitzgerald, MD. Facial shaping with fillers.  Advances in Beauty. Medscape Dermatology.
  • Bermann PE. Aging skin: Causes, treatments and prevention. Nurs Clin N Am 2007;42:485-500
  • Glogau RG. Physiologic and structural changes associated with aging skin. Dermatol Clin 1997;15(4):555-59
  • Fisher GJ, Varani J, Voorhees JJ. Looking older. Fibroblast collapse and Therapeutic Implications. Arch Dermatol 2008;144(5):666-72
  • Friedman O. Changes associated with the aging face. Facial Plast Surg Clin NA 2005;13:371-380
  • Hruza GJ. Rejuvenating the aging face. Arch Dermatol 2004;140:1383-86
  • Leveque JL. Quantitative assessment of skin aging. Clin Geriat Med 2001;17(4):673-89
  • Shaw RB et al. Aging of the mandible and its aesthetic implications. Plast Reconstr Surg 2010;125(1):332-42


How do I get started?

To schedule an appointment with Dr. Altman, please call Summit Medical Group Dermatology at (908) 277-8668.

Summit Medical Group provides medical, surgical, and cosmetic dermatology for women, men, and adolescents in the tri-state area, including New York and New Jersey as well as Essex County, Morris County, Bergen County, Union County, Passaic County, Somerset County, Sussex County, and Livingston, NJ; Millburn, NJ; Short Hills, NJ; West Orange, NJ; Berkeley Heights, NJ; Caldwell, NJ; Cedar Grove, NJ; Cedar Knolls, NJ; Chatham, NJ; East Hanover, NJ; Englewood Cliffs, NJ; Essex Fells, NJ; Fair Lawn, NJ; Florham Park, NJ; Fort Lee, NJ; Glen Ridge, NJ; Jersey City, NJ; Kennelon, NJ; Madison, NJ; Maplewood, NJ; Mendham, NJ; Montclair, NJ; Montvale, NJ; Morristown, NJ; New Providence, NJ; North Caldwell, NJ; Parsippany, NJ; Randolph, NJ; Roseland, NJ; South Orange, NJ; Springfield, NJ; Summit, NJ; Union, NJ; Verona, NJ; West Caldwell, NJ; Whippany, NJ; and Westfield, NJ.

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