5 Dimension Plan

5 Dimension Skin Plan™


Derma Skin Institute was founded on an all-encompassing, integrative and science-based approach for maintaining healthy skin as well as delaying and reversing the signs of aging.

We use the latest science, research, medicine and technology to hack the aging process. We are so fundamentally committed to this core principle that it’s in our clinic’s name – deRMA stands for “Dermatology Research Medicine Aesthetics”.

As an institute, we teach, develop and implement strategies on the cutting edge of skin care. With 20 years of research and experience, Doctor Sajic has developed a unique and innovative 5 Dimensions Skin PlanTM and 5 Dimensions Skin LiftTM  that addresses the interrelated dimensions of your skin health, aging and disease. This integrative approach will help to hack and delay the signs of aging – helping us bring out the best version of you.

A case example

Here is a case example of a transformation of one of our patients who is in her early 40s. Like many patients who come to our clinic she found that her appearance / what she saw in the mirror was no longer matching how she felt on the inside. She was also not interested in surgical approaches like a face lift as she did not have time for the downtime, did not want to go under general anesthetic and did not want any scars (even if they were well hidden). By utilizing a combination approach that addressed all 5 dimensions we were able to achieve a natural, balanced and youthful appearance

How do we achieve such results?

Just like you wouldn’t want to build your dream house on quicksand, when tackling the signs of aging we always start with the foundation!  What’s beautiful on the surface won’t last without the proper supports.

The 5 Dimension Skin Plan addresses every component of what ages us and makes us look older. Each of these dimensions’ experiences degradation, deflation and descent. As such it is important to look at how much each is affected and intervene only enough to restore your freshest and most natural you.

The approach is intricately linked the science of the aging process. By understanding how, what and why aging is showing itself we can hack, modify, prevent and reverse many of the stigma of aging.

How do we achieve such results?

It is very important that we all age differently. While we will talk about typical age groups and treatment approaches we consider at each stage, we all age differently. Furthermore we all age differently in each of our 5 Dimensions!

For example someone may have fantastic cheek structure of a 25 year old while having the skin texture and pigmentation of an average 60 year old! Have you ever stepped on the scale that measures your muscles, fat and hydration and gives you a Bio-Age? Well our skin is no different. And its not just in one aspect but in each of the 5 Dimensions! Our genetics, habits, environment and our skin care routine all play a role.

One of the critical hallmarks of aging is the Triangle of Aging. This triangle is all about the key points our eyes are drawn to when looking at someone. In our youth people notice our eyes, high cheekbones and a smooth pointy chin. These lines form an inverted triangle.

As we age this triangle is flipped! The most prominent features start to become glabellar wrinkles, bags under our eyes and the jowls.

How we are different

When other clinics focus only one aspect – like only using fillers to correct loss of volume in the skin – it can lead to unnatural results and overfilled syndrome like dreaded Pillow face.

We differ for other clinics because every treatment is uniquely tailored to you and your specific skin needs. We understand that aging not only inverts the triangle of youth but that it does it by affecting all 5 Dimensions of the face. All of our treatment plans are designed with the assessment of all five of the dimensions of aging and skin health. While you may not need all 5 Dimensions treated – it is important to at least address them and plan for it in the future. It is also important to understand that they are all connected and that overdoing one area may negatively impact the other dimensions.  The approach enables us to deliver a uniquely curated blend of cutting-edge technology and products to address your skin needs and optimal health. The 5 Dimensions Skin Plan and Skin Lift is only available at Derma skin Institute.

To avoid the dreaded pillow face we have to think of treating all of the 5 Dimensions

  1. Bone loss, changes or hypoplasia (small chin, sunken cheeks)
  2. Fat loss or displacement  (Festoons, Malar bags, Jowls, double chin)
  3. Structural skin loss – degradation of elastin, collagen and hyaluronic acid
  4. Textural changes to the skin surface (brown spots, red spots, scarring and wrinkles)
  5. Muscle and movement imbalances (forehead lines, 11s, crows feet, Marionette Lines)

Typical Treatments

It is difficult to give a “typical treatment” an exact quote or plan without seeing you in person. All treatments are custom tailored to you. We aim to give you more years of youth and healthy-looking skin. However, there are some loose generalizations on the treatments we offer.

Before getting into it, it is important to remember that nothing replaces an in person consultation and treatment with a board certified dermatologist or plastic surgeon. Only they have rigorous training and rigorous examinations that ensure that you’re getting the absolute best. You wouldn’t want anyone other than a cardiac surgeon working on your heart and you should have same standards for your cosmetic procedures. The plan and treatment or only as good as the person performing them.

Much of what happens here is all about prevention!!! Starting a skin care routine is absolutely key! Everyone should be protecting themselves from the sun, pollution, and increasingly blue light form electronic devices!! (yes too many selfies can make you look older!). Generally skin care should at the very least include sunscreen, retinol and vitamin c for everyone. Make sure you get a good quality product as recent studies have shown that 90% over the counter vitamin c products are not effective! Know your science and know the tricks some companies use!

Also make sure you get enough sleep, eat right, exercise and try to minimize stress (did you know that one deep breath per hour with your eyes closed can significantly reduce your stress and blood pressure!!)

Summary of most common treatments

Botox / Dysport / Xeomin – more preventative
Facials / Professional Exfolation / Dermabrasion
Microneedling
Rejuvenating and Glowing Lasers  –  Clearlift, DyeVL, IPL, BBL, Clear and
Brilliant
Skin care!  – sunscreen, Vitamin C, Retinol

Specific Issues in the 5 Dimensions

  1. Bone loss or changes:
    – typically not an issue here! However, you may have a genetically small chin or cheeks that may benefit from strategically place structural fillers.
  2. Fat loss or displacement.
    Again, not really an issue here unless you have a genetic predisposition to large malar bags or fat pads. If you enjoyed the sun you may also start seeing early festoons here. This can be corrected with soft fillers like Restylane silk or Belotero Soft
  3. Structural skin loss. Again – lucky you – not much to do here.
    It may be good to consider preventative collagen stimulation (we start to loose collagen and hyaluronic acid in our early 30s!) Microneedling every 6-12 months is an excellent way to maintain and prolong.
    Some patients may have genetically smaller lips that they wish to augment or enhance. Our goal is always to make it look natural and balanced for your face. Because lips may need both structure and softness it is not uncommon for us to recommend two different types of fillers here (Belotero Contour and Belotero Shape are one we use very frequently).
  4. Textural skin surface:
    Acne may be an issue here as can rosacea and early pigmentation changes. Generally, we don’t have to go aggressive here and can start with Hollywood / Minimal to zero downtime treatments. Bela Facials can be customized to your skin type to give you the optimal glow, hydration and texture. Laser treatments like the Clearlift or IPLs like DyeVL or BBL are common here to maintain optimal skin surface youthfulness, even skin tone and glow.
  5. Muscle and movement:
    This is where the frown lines start. Properly placed and preventative neuromodulators and muscle relaxers like botox, dysport or Xeomin are key here to pre-juvenate and prevent ingrained wrinkles. This is by far, along with facials is by far the most common treatment for your group.

Summary of most common treatments

Treatment

  • Botox / Dysport / Xeomin – treatment and reversal
  • Dermal Fillers – Structural (Radiesse, Lyft), Volumizing (Volyme, Voluma) and Hydrating (skinboosters)
  • Radiofrequency Microneedling (Morpheus8) – for skin tightening, collagen building, elastin building
  • ClearLift laser – (4-6 sessions initially) texture, pigmentation, fine lines,
  • DyeVL or IPL  – (3-6 sessions) – redness, rosacea, light pigmentation

Maintenance

  • Botox / Dysport / Xeomin – treatment and reversal  (every 3-4m)
  • Facials / Professional Exfoliation / Dermabrasion (every 6-8 wk)
  • Micro-needling (1-2 times per year)
  • Rejuvenating and Glowing Lasers  –  Clearlift, DyeVL, IPL, BBL, Clear and Brilliant (one session every 8-12 months) – ie every third botox treatment is a good reference
  • Radiofrequency heating: Juvashape, Vshape, Thermage (every 8-12 months)
  • Skin care!  – sunscreen, Vitamin C, Retinol

Specific Issues in the 5 Dimensions

  1. Bone loss or changes:
    – start to see changes in bone loss and loss of cheek and chin projection. Consider 1-2ml of structural filler to enhance / rebalance lost projection and contours
  2. Fat loss or displacement.
    More of us start to develop malar bags or sunken fat pads. If you enjoyed the sun you may also start seeing early festoons here. A bit of volumization of cheeks with volumizing hyaluronic fillers (Belotero Volume, Restylane Volyme) as well as in the nasolabial folds and marionette lines can help reverse this
  3. Structural skin loss.
    We start losing 1ml of Hyaluronic acid per year starting as early as age 30! In addition, collagen and elastin begin to decrease in structure, density and volume. As a result, the skin starts to lose its firmness, elasticity and hydration and gravity begins to take over. To beef up the collagen production we often recommend controlled wounding therapy with microneedling to start. If there is more than drooping than expected, we may suggest Radiofrequency assisted microneedling with Morpheus8 or RF Pixel.  Elastin is usually fairly good at this stage and prevention or minimal stimulation can be sufficient. This can be done with radiofrequency heating with vshape, juvashape, themage or other heating devices. Again if more than expected biostimulatory fillers like Radiesse or Sculptra can be added as can Morpehus8. Consider doing these types of treatments 1-2 times per year to maintain your results!
  4. Textural skin surface:
    This is where we start to see the effects of sun damage and aging and UV associated pigmentation changes. The texture of the skin also goes from being smooth to a bit more rough or uneven. With a lot of sun damage our skin gets in to hibernation mode known as senescence. This will lead to accelerated aging and increased risk of skin cancer. Fortunately, we can wake the cells with resurfacing lasers or Microneedling. For pigmentation at this stage we generally consider combination treatments with less aggressive lasers (ie Clearlift and DyeVL combination) plus minus chemical peels – depending on the response. For more severe pigmentation we may need to consider more aggressive lasers like CO2 or Erbium YAG.
  5. Muscle and movement:
    This is where the frown lines really set in and it is more important to treat every 3-4 months with Botox, Dysport or Xeomin

Summary of most common treatments

Treatment

  • Botox / Dysport / Xeomin – treatment and reversal
  • Dermal Fillers – Structural (Radiesse, Lyft), Volumizing (Volyme, Voluma) and Hydrating (skinboosters).
  • Radiofrequency Microneedling (Morpheus8) – for skin tightening, collagen building, elastin building – recommend a package of 3
  • Erbium or CO2 laser – more advanced texture, pigmentation, deeper lines and wrinkles and sun damage

Maintenance

  • Botox / Dysport / Xeomin – treatment and reversal
  • Facials / Professional Exfoliation / Dermabrasion every 6-8 wks
  • Mopheus8 every 6-12 months
  • Rejuvenating and Glowing Lasers  –  Clearlift, DyeVL, IPL, BBL, Clear and Brilliant (every 3-6 months – ie every other botox treatment
  • Radiofrequency heating: Juvashape, Vshape, Thermage (every 6-12 months)
  • Skin care!  – sunscreen, Vitamin C, Retinol

Specific Issues in the 5 Dimensions

  1. Bone loss or changes:
    More pronounced changes in bone loss and loss of cheek and chin projection. Consider 2-3ml of structural filler to enhance / rebalance lost projection and contours
  2. Fat loss or displacement.
    More pronounced malar bags or sunken fat pads. Upper eyebrows begin to droop and festoons are more common. Consider a surgical or a minimally invasive procedures here. Filling alone with fillers becomes more difficult and it is important to also add Skin tightening and lifting to avoid the dreaded Pillow face. A series of skin tightening devices combined with Morpheus8 can be a great option for many patients here. The skin will tighten, lift and become much more firm and elastic.
    For some patients with more pronounced sagging AccuTite is a great noninvasive option to avoid or delay a surgical lift. Accutite can be done for the Jowls, eyebags, nasolabial folds, and neck. We can even use it to preform a non surgical brow lift.
  3. Structural skin loss.
    Just like exercise, if you have carried out your maintenance in the earlier years, your skin gains will be easier to maintain.
    Regardless, this is where father time takes it up a notch and we have to also up our game. Elastin takes a big hit at this stage so restoring it will be key to looking your best. While one treatment may work well, it is good to think of combination treatments at this stage
    I usually at this stage when one can consider a face lift. However many patients in our clinic are not yet ready for this and come to us seeking the best minimally invasive procedure. Luckily, we have the latest in expertise, science and technology to give you the best noninvasive lift available.
    To really boost your elastin production and tighten and lift your skin a combination of Morpheus8, AccuTite and/or Dilute Radiese is what we typically begin with. At this stage devices like vshape, juvashape, thermage or other heating devices can also be very helpful but tend to work best as maintenance once we have done the above. Regular maintenance treatments are a little more frequent at this stage.
  4. Textural skin surface:
    Sun damage and textural changes becomes more evident and more pronounced in a greater majority of patients. Similar strategies apply as the previous age group, but we may have to consider more treatment sessions with low downtime / non-ablative lasers or with Morpheus8.  To boost collagen and remove more pigment it is important to consider fractional ablative lasers more frequently with CO2 or Erbium YAG lasers. Combination again is key for many patients as any one modality is able to do less on its own.
    Hyaluronic acid deficiency becomes much more pronounced and it is important to consider both volumizing and smoothing very superficial fillers like Skinboosters.
  5. Muscle and movement:
    Again Botox, Dysport or Xeomin are especially important. However, it becomes less likely that they can get the desired outcome on their own. It is frequently important to add other modalities to achieve the optimal results

Very similar to above age group in terms of noninvasive treatments. Again, it may be prudent to consider surgical revision / surgical face lift here. Many of our patients come to us because they want to avoid surgery or at least delay it. Combination treatments to Lift, fill and tighten are critical to give the most natural results. Generally we suggest the full Dr Sajic 5 Dimension Skin Lift to achieve the best results for most of the patients as generally the majority of our patients who have not kept up with their skin routine in the previous age groups will need to attack the problem from many angles

Start

AccuTite and Morpheus8 combination – lift the Jowls, eyebrows marionette lines while building elastin

CO2 Laser resurfacing to erase deep lines and wrinkles, build collagen and erase pigmentation and wake up sleeping cells, increase DNA repair mechanisms

Dermal fillers to Lift volumize and hydrate. Important to consider different types of Hyaluronic Acid fillers as well as biostimulatory fillers like Radiesse and Scluptra

Botox / Dypsort / Xeomin to relax the muscles that contribute to engraining the deep wrinkles

Maintain

Regular maintenance is essential to keep the gains

Botox / Dysport / Xemoin every 3 months

Morpheus8 every 6-12 months

Vshape radiofrequency every 3-4 months

Clearlift Laser every 4-6 months

Hydrating skin facials and dermabrasion every 6-8 months