I’ve received lots of emails lately about ageing, skin and ways to combat the march of time.
More and more, the questions have been turning to cosmetic procedures – Botox, fillers and what they actually do.
For answers, I turned to my beauty editor friends for advice on which cosmetic surgeon was the best.
I wanted safe, balanced and super-experienced.
Enter Dr Anoop Rastogi who specialises in subtly with a philosophy that ageing doesn’t need to be stopped but it can be enhanced.
Here, he talks about super foods, the importance of sleep and the latest innovations in non-invasive cosmetic procedures.
The Q & A.
Q: At what age do women really start to experience the ageing process?
The turning point for ageing in women is around your early to mid thirties. This is when the collagen and elastin content in the skin starts accelerated depletion. Fine lines and wrinkles that were temporary start to become permanent.
Change in the bone structure tends to happen around the mid to late forties. As well as changes in the bone structure, women lose a little bit of facial fat. The combination of the loss of fat and the reabsorption of the bone start to make the face sag and that youthful plumpness fades.
Q: What are the best ways to combat the early signs of ageing?
Your lifestyle is very important. Sleep without a doubt plays a big part in the signs of early ageing. The difference between a good night’s sleep and a late night out is not something you can easily hide on your face. We say ‘get eight hours sleep a night’ because it’s convenient in the modern society but eight hours sleep is the minimum requirement for youthfulness.
Q: What are your top three tips for helping slow down the ageing process?
Cosmeceutical skincare: I don’t mean over-the-counter skincare products, I mean the proper stuff you get from a cosmetic surgeon or dermatologist that boosts collagen, stimulates the skin, guards against damage and deeply moisturises the skin.
Healthy lifestyle: Most importantly sleep and sun protection. If you smoke and drink too much, of course that’s also going to speed up the ageing process.
Q: How big a role does food play in fighting ageing?
Food plays a huge role for a whole number of reasons. The food we eat contains the basic building blocks that make the hormones that nourish our skin. The estrogen that a woman needs to keep her skin looking youthful comes from the good fats in the food that she eats.
Antioxidants are also vital. The skin ages because of free radical damage from environmental pollutants and ultra violet radiation from the sun. Foods that contains antioxidants mop up those free radicals so they can’t damage the skin.
Q: What kinds of foods should we be eating to help combat the process from the inside out?
Your diet should include fruits that are high in antioxidants. Goji berries are very high in antioxidants, and so is star fruit. But the food with the highest antioxidant value of any food that we know of is actually the Kakadu plum, although it’s unfortunately not readily available.
Like your mum always said, you need to eat plenty of fruit and vegetables as they not only contain antioxidants but a whole lot of other vitamins and minerals that are all important for the little micro-metabolisms that occur in the skin and throughout the body to keep it youthful. It’s best to eat them when they’re fresh and whole.
Once they start being processed or overcooked, they lose their nutritional value. Vegetables that have been picked too early and ripen during transport are not nearly as good as ones that are grown and taken straight to the farmers markets. When cooking your vegetables, it’s best to steam or blanch them. The minerals don’t matter as much as they don’t get lost during the cooking process. Fruit is great because they’re not only rich in both vitamins and minerals that we need for our metabolic processes but they are generally eaten raw.
You also need protein to keep repairing your collagen and other body tissues, because even if your skin is looking good the muscle beneath the skin will start to deflate and your face will sag and appear aged. You also need good fats to keep your body producing the hormones that nourish the skin and send the signals to the rest of your body to repair damage.
Q: What are your thoughts on fruit’s high sugar content?
Not all fruit will make you gain weight because of its sugar content. The Glycemic Index will guide you in finding the best fruits to eat, and which ones you should avoid. The Glycemic Index (GI) is a measure of how quickly the sugar in the food is absorbed into the blood stream. The lower the GI value, the slower the sugar takes to be pumped into the bloodstream.
If you eat fruits like watermelon, which has a very high GI value, it gives you a sugar spike that can lead to weight gain. Peaches and cherries are an example of a low GI. Pears and apples are also relatively low. A GI of 100 is really high, while 0 is the lowest. Peaches have a GI value of about 38 and apples are about 43.
If it’s below 55 it’s really good. Moderate your intake of fruits like watermelon and pineapple, but eat plenty of low GI fruits like peaches, apricots, apples and pears.
Q: When it comes to skincare products, what do your recommend and which ingredients give the best results?
The skincare products that you’ll get from your cosmetic surgeon or dermatologist will work because they’ve been clinically proven to work.
In terms of preventing the skin from ageing, the key ingredients to look for are antioxidants, vitamins A, C and E, and a really good sunscreen. Then, to make the skin look youthful you need to remove fine lines and wrinkles plus reverse the signs of sun damage. To reverse the signs of sun damage and allow supple new skin to come to the surface you need an exfoliant; vitamin A and C derivatives are your go-to ingredients.
Another tell-tale sign of aged skin is a dull and flat appearance. To make the skin look more translucent and glowing you need niacinamide, which is concentrated vitamin B3. Niacinamide helps get rid of pigmentation by drawing the pigmentation out of the skin and improves the translucency of the skin for a more radiant appearance. Finally, you need a really good moisturiser. Aged skin looks dull and dry so you need a good cream that can penetrate deeply.
Q: What are four skincare products that every women needs in her routine?
Sunscreen in Australia is number one, both for prevent ageing and preventing skin cancers. The second is a really good moisturiser to maintain the skin’s barrier against the environment. The third essential product is one that’s going to prevent free radical damage in the skin, which an antioxidant-rich product will do. The fourth thing you need is a skincare product that’s going to allow the skin to repair well plus stimulate collagen production and promote blood flow.
Q: Which celebrities are examples of considered subtle cosmetic procedure?
My favourite example is Michelle Pfeiffer. If you look at her back when she did Grease 2, she had circles under her eyes and didn’t look as good then as she does now. But everything that she’s had done, she’s done inconspicuously and gently, and she looks elegant and lovely.
Jennifer Aniston is another great example. She always looks natural. And Angelina Jolie. Her skin always looks good, her cheeks are always nicely formed and she never looks like she’s overdone.
Q: What is the difference between Botox and dermal fillers?
Botox relaxes muscles and will stop the muscle that’s causing the wrinkles from contracting. Once we apply Botox, the wrinkles essentially fall out.
A dermal filler actually plumps out the line with hyaluronic acid. It’s perfect for areas where there’s plenty of movement, such as around the mouth.
Q: But doesn’t Botox tighten muscles, rather than loosen them?
No, that’s a common misconception. Botox doesn’t actually tighten the muscles, it does the opposite. There’s a yin and a yang.
For everything that pulls muscles one way, there’s another muscle pulling it the other way. Gravity pulls everything down so we rebalance the muscles and give the muscles that lift an advantage to the muscles that pull down. So we’re actually lifting rather than tightening.
Q: You are very against the frozen forehead look that Botox can produce. What should women be careful of when undergoing a Botox treatment?
Lots of doctors and non-doctors have learnt how to inject Botox but good Botox is an artistic skill. If someone is following a recipe formula for injecting then everybody will look the same and faces look flat. The best doctors can read individual faces well and know where to best highlight your features. You want to reduce the signs of ageing but keep the character of the face. That’s the difference between good and bad work.
Dr Rastogi’s patient before and after Botox.
Q: What new ways are you using Botox in your practice?
We traditionally know that Botox gets rid of angry frown lines in the centre of the forehead and the crows feet around the eyes. A little more advanced than that we can use Botox to rebalance the muscles of the face to allow the Botox to be an anti-gravity agent that lifts the eyebrows up.
As we get older, our eyes get smaller because the fat around the eyes is lost and they drop further back into the eye socket, the brow comes down, and the lids get heavy. We can make eyes look bigger by very precisely injecting Botox into parts of the eyelid that cause the eyes to open up more. We do that in combination with lifting the brow a little.
With age you get that droopy kind of sad look around the mouth. We can turn that up and lift the corners of the mouth by skilfully injecting Botox into the small muscles below the mouth.
Then with more advanced procedures we can do a little facelift. It’s called a Nefertiti Lift. What we do is inject Botox into the neck just below the jawline to relax the muscles that pull the skin down over the jawline and cause your face to look more aged.
Then if we get more advanced still, we can change the shape of the face. Lots of people hold stress in their jawlines. This can cause women’s jaws to appear bigger and thicker. Once upon a time the way to give you an elegant Audrey Hepburn jawline was to have surgery and basically shave the jaw down. Now we inject Botox into it to shrink the big chewing muscles at the edge of the jawline, resulting in a slimmer-looking lower face.
We can also help people who suffer from migraines and stress headaches. People tend to hold their tension at the back of their neck and also in their temples, so we inject Botox in these areas to loosen the muscles.
Q: Is Botox safe for all women? And how long does it last?
Botox is a completely safe product. There are very few places it can be injected that will cause harm and allergies to Botox are virtually unreported.
Botox results vary depending on how we’re using it. Botox in the normal cosmetic areas lasts between three to six months. When we’re injecting things like the jawline to sculpt the face, it lasts eight months to a year. When we inject to stop sweating under the arms, it works for up to a year.
Q: Explain injectables. What are your options?
We use hyaluronic acid in our dermal fillers. Hyaluronic acid is a completely naturally occurring substance that is found in all of our cells and all of our organs. It’s part of the human body and your body manufacturs its own hyaluronic acid. When we use it in injectables it actually stimulates the production of your own hyaluronic acid as well as collagen. It’s very bio compatible, which is why we have very few problems when using dermal fillers. Hyaluronic acid comes in two different properties, stiff and soft, and we use each one differently depending on what area we’re injecting them into. A stiffer, thicker hyaluronic acid is used during a chin augmentation or a non-surgical rhinoplasty. If we’re treating finer lines or soft tissue like the lips, or getting rid of the dark circles under eyes, we use a softer product of hyaluronic acid.
Fat replacement has gotten better and better over the years. Previously when you would take fat from one area and inject it somewhere else, you would often get a lot of swelling and bruising in the area it was being injected into. It still produces some swelling and is less precise that dermal fillers, but it’s good for significant augmentations in the cheeks and the lower face. People who have had significant weight loss or people who have exercised so much that their face is looking very empty often need fat replacement in their lower face.
Sculptra is a little more permanent but not as precise so I prefer not to use this type of injectable. When I do something I want absolute precision and you don’t get that with Sculptra. There are more reliable injectables, such as fat replacement and hyaluronic acid.
Q: What are some mistakes that you see other doctors making with injectables?
Overdoing it. Less is more. Once you’ve crossed that line and it no longer looks natural, it detracts from your beauty. That is probably the biggest thing, plus not understanding the very intricate parts of the anatomy means their patients don’t get the best out of their Botox. They might get rid of the frown lines in the middle of the forehead, but the brows look heavy as a result and so you’re making a trade off. With a better understanding of the anatomy you can have your cake and eat it too!
Q: You’re not a fan of the “Y” Lift. What is it and what should we be weary of?
A Y Lift is the name given to a pattern of injections administered to the face to plump up the cheeks and remove the signs of ageing from the lower face. Does it work? Yes it does, but it’s a recipe book approach to Botox where you inject in a certain way to create a lift. It’s a technique that’s been developed that lots of doctors can use, which is good in that sense. The average injector can produce a decent result, but it doesn’t take into consideration your personal features or face shape. Instead, by skilfully adding Botox you can harmonise the face so that when people look at you they think ‘wow you look good but I just don’t know why.’
Q: How do you use cosmetic procedure to combat the following common ageing concerns?
Fine and dynamic lines
If they’re in areas suitable for Botox, and most areas are, then Botox is the primary treatment for fine and dynamic lines. Particularly in the upper face around the eyes and in the forehead where frown lines are. If it’s around the mouth then we’re more likely to use the finer dermal fillers because this area needs to move more naturally.
Lines caused from smoking
My first piece of advice is to stop smoking. But if the damage is already done, the most common treatment is to use hyaluronic acid dermal fillers as most lines caused from smoking are around the mouth.
We treat most acne scarring with microdermabrasion, lasers or a peel. When scarring is too deep for these treatments to work, we fill the scarring with hyaluronic acid. If a patient has deep or big areas with scarring, they can respond really well to dermal fillers. Patients with finer acne scars can see results from our treatment in as little as one visit, while more sever scarring will need to be treated broadly a couple of times, then we target any problem areas after that. The way our acne treatments erase scars is by flattening the skin around it so the acne scarring disappears.
The best thing for acne is to treat it while you’re a teenager. And thanks to advances in technology, we can now do that. Teen acne can be treated with blue and green wave length lasers that can shrink the glands. This treatment should be complimented with really good skincare products. If all else fails, go onto Roaccutane. But that should be your last resort.
Q: What checks should be made on a cosmetic surgeon before undergoing a procedure?
Most doctors in Australia are well qualified; it’s just the nature of medicine here in Australia. But there’s a very big difference in the level of talent among these qualified surgeons. Word of mouth is everything and that’s just not ‘my friend went to someone and they kind of had a good result.’
Do your research and find someone who consistently comes up with great reviews and someone who has a great reputation. That’s the person you need to see. Not just because the results will be good, but because it also means the complications rate is extremely low. They’re the two things you want to know – you want to know that you’re in really safe hands and that you’re going to get a beautiful, natural looking result.
Q: What’s on the horizon?
The big things on the horizon are understanding the ways hormones interact with the skin and the tissues better and using the research to treat ageing, plus using stem cells to help us regenerate tissue and stop them from ageing. Prevention is also a big focus.
REPORTING by CHELSEA TROMANS