Dr. Patel’s Approach to Treating the Aging Face: 4D Anti-Aging

For me, it’s an exciting time to be an aesthetic medicine provider. Actually, it’s probably just as exciting to be a patient, at least for those interested in cosmetic medicine. Today, more than ever, aesthetic physicians have the tools needed to provide natural looking and aesthetically pleasing results without surgery and with minimal downtime. We are essentially able to freeze the aging process.

4d aging blog graphic
Anyone that has seen me for consultation or treatment in my Coral Gables clinic knows that I frequently describe my approach to treating the aging face as “4D anti-aging.” 4D or 4 dimensional antiaging is the idea that a combination treatment approach using multiple (four in my approach) modalities is required when addressing the aging face. To understand the important role of each of the 4 treatments, it is important to understand the underlying causes of aging.

  • First, hyperdynamic muscles such as muscles in the forehead and around the eyes lead to dynamic and eventually static lines and wrinkles predominantly on the upper face (i.e., frown lines, horizontal forehead lines, crow’s feet). While we mainly focus on the upper face, hyperdynamic muscles are also responsible for loss of jawline definition (platysma), vertical neck bands (platysma), perioral or vertical lip lines (orbicularis oris), and downturned corners of the mouth (DAO).
  • Second, age-related volume loss from fat, muscle, and bone atrophy leads to sagging of the skin and changes in the face such as laugh lines, jowls, loss of jawline and cheek definition, undereye and temple hollows, lip elongation and volume loss and perioral lines.
  • Third, years of sun exposure and environmental stressors such as atmospheric pollution, stress, smoking, and diet leads to skin changes that result in hyperpigmentation, enlarged pores, uneven tone and texture, and loss of radiance.
  • Fourth, collagen loss and elastin degradation lead to skin laxity which is one of the hallmarks of the aging face.

So the four treatment modalities that I am talking about when I talk about 4D antiaging are:

  1. Regular treatment with neurotoxins like BotoxDysport or Xeomin to reduce muscle activity and soften the appearance of frown lines, forehead lines and crow’s feet. By regular treatment, I mean at least 3 times a year. This is an important point as many patients will come in and have Botox once or twice and then not get it done again for years. In my opinion, this is pointless. The best results are seen in those patients who maintain their results with regular treatments. The muscles atrophy, the lines get softer, and in many cases even difficult to treat “etched lines” improve with regular treatment.
  2. Correcting volume loss with dermal fillers such as Restylane, Juvederm, and Sculptra. When it comes to treating age-related volume loss, my preferred filler is Sculptra. Sculptra is a filler made of poly-L-lacitc acid particles. What makes Sculptra unique is that unlike hyaluronic acid based fillers like Restylane and Juvederm, Sculptra works by stimulating your body to produce more of its own collagen. We already know that volume loss is in a big way due to collagen loss and so it makes sense that the best filler to address this volume loss is one that results in more collagen production. Now this doesn’t mean that hyaluronic acid-based fillers are unnecessary. It just means that they should be used in combination with Sculptra when possible and when appropriate. The way I look at it is that Sculptra is a facial volumizer while Restylane and Juvederm are line and wrinkle fillers (i.e., nasolabial folds, marionette lines, etc.). Most of my patients see me once every 9-12 months (once full correction is achieved) to maintain their filler results.
  3. Skin resurfacing with fractionated lasers (Clear + Brilliant), microneedling, and chemical peels to improve skin tone and texture, address hyperpigmentation, shrink pores, soften fine lines, and increase radiance. My patients really like that most of the resurfacing treatments we offer are quick, result in only minimal downtime, and provide noticeable and consistent results.
  4. Skin tightening using radiofrequency based devices. While both radiofrequency (Thermage, ThermiRF, Infini), ultrasound (Ultherapy), and laser devices can be used to stimulate collagen production and thereby improve skin laxity, my preferred treatment for nonsurgical skin tightening is Thermage (either the 3rd generation Thermage CPT or the 4th generation Thermage FLX). Thermage was the first energy-based device approved by the FDA for skin tightening back in 2001/2002 and since that time over 2 million Thermage treatments have been performed worldwide and over 50 clinical studies have confirmed its safety and efficacy.

So that’s my approach to the aging face. There is just one more thing. In addition to the four office-based treatment modalities above, I always start my patients on a complete at-home daily skincare regimen which brings it all together. Important active ingredients I find myself constantly recommending are physical sunblockers, antioxidants such as vitamin C and E, green tea, and resveratrol, glycolic acid, retinol or retin A, and skin brighteners (both hydroquinone and hydroquinone free products). Latisse, a prescription topical medication, has been proven to increase eyelash length and fullness and is very popular among my patients. Some of my favorite medical grade skincare lines are Alastin, Skinceuticals, Restorsea PRO, and EltaMD.

If you are ready to experience the 4D approach to antiaging, call Miami Skin & Vein today at 786-618-5039 to schedule your personal consultation. We welcome patients to our Coral Gables office from Miami, Fort Lauderdale, and neighboring Florida communities.




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Miami Skin & Vein is the best place to go if you want natural and excellent results. The staff and Dr. Patel are so nice, love coming back to Miami skin & vein!

–S.M., Actual Patient*


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