Dr Ryan’s Personal Skin Care Regimen

Almost every day, a patient asks me, “What do you do for your skin, Dr Ryan?” The truth is that for years, I did absolutely nothing for my skin. In fact, until I was around 37 or 38, I purposely tanned my face. I remember skiing at Aspen and trying to get as much sun as possible on my face; I would sit on the deck at Bonnie’s having lunch and rotate my body to follow the sun so my face got maximum exposure! My face was almost purplish, it was so sun-damaged.

As someone of Irish heritage, I am what’s classified as a Fitzpatrick skin type II, meaning that I have fair skin and blue eyes and that I burn easily in the sun. My skin issues pertain mainly to dilated (or “broken”) blood vessels and ruddiness. Therefore, I need a skin care regimen that is very gentle so that more blood vessels do not “break,” which would lead to even more ruddiness. On the other hand, many people with olive skin and brown eyes (Fitzpatrick skin types III and above) have issues with hyperpigmentation (i.e., brown spots or patches), not ruddiness and broken blood vessels. Therefore, these patients often need to focus on beaching creams such as hydroquinone or kojic acid. People with significant sun damage, fine lines and brown spots may need to focus more on products that contain ingredients that help to reverse sun damage; these ingredients include kinetin, retinol or acids. In people with sensitive skin, however, some of these ingredients may be irritating.

In the last five years, I have made great strides with my skin and here’s how I did it.

1. Gentle cleanser and moisturizer – Because of my sensitive skin, I require a very mild cleanser and moisturizer. However, I could never find one that met my exact specifications. So I decided to develop my own. Every morning and night, I use the Dr Frank Ryan cleanser and moisturizer. For people who prefer their skin care products to be paraben and sulfate-free, I also have a paraben and sulfate-free cleanser. The products are aloe-based, and contain ingredients like sage and arnica.
   


2. Broad-spectrum, high SPF sunblock – This is the most important thing for good skin. About five years ago, I began using a daily moisturizer with an SPF of 15. After a year or two of doing that, it occurred to me that I should probably use something stronger. So I tried many different sunscreens and concluded that the Skinceuticals SPF 45 was the best, in my opinion. It does not leave the skin white and provides excellent broad-spectrum coverage, since its main ingredient is zinc oxide, still the best sunblock out there in my book. This alone began to improve my skin dramatically. Other excellent sunblocks are made by Epicuren and Fenix. I am currently formulating my own sunblock for the Dr Frank Ryan line.
   


3. Skin Refining Gel – My secret weapon is the Dr Frank Ryan Skin Refining Gel. This product is very difficult to categorize, but in general, it serves to minimize or even eliminate the appearance of pores, fine lines and irregularities in skin texture or tone. It contains several topical vitamins, arnica and alpha-lipoic acid and is lightly tinted. Remarkably, many men are absolutely hooked on this product, because it improves their skin significantly, but is not considered “make-up”. When people comment on my skin, I always confess that I had a little help from my Skin Refining Gel.
   

There are many, many excellent products on the market that I don’t use only because they are not what my skin needs. Product lines like Kinerase and Epicuren are excellent and we carry both lines in my office. Individual products like Renova and Tri-Luma and Cellex-C are all excellent.

Bottom line: each person needs a skin care regimen specifically designed for his or her own skin type. A product like Renova, which would be beneficial for many people, would simply be too strong and irritating for my sensitive skin. On the other hand, a simple, gentle skin care regimen like I use would simply not be strong enough to help someone with severely sun-damaged, weather beaten skin.

Next up: the laser and light therapy devices that I have used – and to continue to use – to improve and maintain my skin.

The Mini-Facelift under Local Anesthesia

For most of my fifteen years in practice, I performed the vast majority of my facelifts under general anesthesia with the patient asleep. About three or four years ago, a very determined young lady practically begged me to do her mini-facelift under local anesthesia, meaning that she would be awake. Because she had a high pain threshold and was stoic by nature, I agreed to do so. The procedure was a breeze and she raved about how easy the process was and how quickly she recovered. After that, I began to do more and more mini-facelifts -- and even more extensive facelifts -- under local anesthesia. I realized that in some cases, I could accomplish the majority of what I needed to accomplish without general anesthesia – the key was to choose the patients carefully and to educate the patient beforehand about what to expect.

When performing a facelift under general anesthesia, we routinely require the patient to obtain preoperative blood work and other tests, including an EKG and a chest X-ray. General anesthesia requires that an anesthesiologist be present, which adds to the expense. Furthermore, there is typically a bit more recovery involved after general anesthesia. Mini-facelifts under local anesthesia, however, usually don’t require the preoperative lab work and an anesthesiologist is not required to be present.

Local anesthesia typically also involves giving an oral medication like Valium; this type of anesthesia is known as “local with oral sedation”. The patient is given Valium approximately 20 minutes before beginning the procedure; that way, the patient is drowsy when he or she is taken into the operating room. Once in the operating room, local anesthesia (lidocaine) is injected into the face, not unlike at the dentist’s office. This is, perhaps, the most uncomfortable part of the entire procedure, more so than the surgery itself. The Valium, however, really takes the edge off this part and most patients say afterward, “The injections really didn’t hurt much at all!” After the local anesthetic has taken effect, the patient typically feels little or no discomfort for the rest of the surgery.

The mini-facelift takes a little over an hour and the patient is walking and talking immediately after the procedure. We typically wrap the face and neck in a light bandage that is removed the next morning when we see the patient in the office. After surgery, we send many of our patients to an after-care facility where they are watched by nurses. However, in some cases, the patient is able to go home if there is a family member or friend who can keep an eye on the patient overnight. Where the patient spends the first night after surgery depends on many variables, including the complexity and length of the surgery and the health and age of the patient. The stitches, located around the ear, are removed in seven to ten days; bruising and swelling is usually minimal. In fact, I am always amazed how quickly patients recover from these procedures. Most are back at work in a week.

In younger patients (30’s and 40’s), the mini-facelift may all they need. In patients in their 50’s and older, other procedures such as a browlift and upper and lower eyelid surgery may also be indicated. As the list of procedures increases, I lean more and more toward general anesthesia.

In older patients, a mini-facelift may still be appropriate. However, these patients need to be educated that a mini-facelift has limits in what it can do. If the neck is extremely saggy, for example, a mini-facelift is probably not the best procedure. Simply put, the mini-facelift can’t accomplish as much compared to what can be accomplished with a more extensive facelift.

In conclusion, the mini-facelift under local anesthesia is a quick and simple procedure that I am incorporating more and more in my practice. The results are excellent and the patients are happy – and that makes me happy.