Plastic Surgeon Ranks 12 Anti-Aging Treatments from Best to WORST

A board-certified facial plastic surgeon discusses 12 popular skincare treatments, ranking them based on effectiveness for facial rejuvenation. Retinol and sunscreen are highlighted as top-tier, with retinol being a collagen-stimulating powerhouse and sunscreen essential for preventing aging and skin cancer. Injectable treatments like Sculptra and Botox are also reviewed, with Botox receiving a high rating for its preventative and smoothing effects on expression lines.

Other treatments evaluated include oral collagen supplements, microneedling, RF microneedling, chemical peels, red light masks, gua sha, UPF clothing, and hydrofacials. The surgeon emphasizes the importance of consistency, managing expectations, and understanding the science behind each treatment. While some treatments offer noticeable results, others are deemed overhyped or less effective, with a few offering more of a temporary cosmetic fix than long-term skin health improvement.

• Retinol is rated 10/10 for stimulating collagen, enhancing cell turnover, and decreasing pigmentation, though it can cause initial irritation.
• Sunscreen is rated 10/10 for protecting against aging, sun damage, and skin cancers, though proper application and reapplication are key.
• Botox is rated 9/10 for its effectiveness in preventing and smoothing expression lines, with a temporary effect lasting 3-4 months.
• UPF clothing is rated 8-9/10 as a smart addition to an anti-aging arsenal for blocking UVA/UVB light, though it doesn't replace sunscreen.
• Hydrofacials are rated 7/10 for deeply cleansing, exfoliating, and hydrating the skin, offering maintenance and a temporary glow with no downtime.

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Retinol [1:06]

• Considered a "holy grail" and a favorite anti-aging ingredient.
• A vitamin A derivative that stimulates collagen, enhances cell turnover, and decreases pigmentation.
• Rated 10 out of 10 for its effectiveness in reversing skin aging and improving fine lines and wrinkles.
• Can cause initial irritation, purging, and require an acclimation phase for some individuals.
• Techniques like combining with moisturizer or slow introduction can mitigate harshness.
• A specific micro-dose technique is mentioned for sensitive skin, offering slow release and reduced irritation.

Retinol is by far my favorite anti-aging skin care ingredient. It's a vitamin A derivative. It stimulates collagen. It enhances cell turnover. It decreases pigmentation. It's a multitasking powerhouse and should be included in nearly every anti-aging skincare routine.

Sunscreen [3:14]

• Rated 10 out of 10 as the most important way to protect skin from aging and sun damage.
• Decreases collagen loss, thinning, fine lines, and wrinkles.
• Reduces the risk of pigmentation, sunspots, and discoloration (brown and red).
• Significantly decreases the risk of skin cancers (melanomas, basal cells, and squamous cells).
• Essential year-round component of any proper skincare routine.
• The main downside is that most people don't use it correctly, including not reapplying or addressing sweat.

Sunscreen is by far the most important way to protect your skin from aging and sun damage and an absolute must-have as part of any skincare regimen.

Sculptra [4:24]

• An injectable treatment that stimulates collagen and increases volume over time.
• Rated 5 out of 6 when used as a volume augment, similar to other fillers.
• FDA cleared for volume augmentation by stimulating collagen in deeper tissues.
• Good for areas like temples or mid-cheeks, but considered a "no-fly zone" near the mouth or eyes due to potential complications like beads.
• Using it near surgical sites can make surgery more difficult due to scar tissue formation.
• Rated 0 out of 10 for improving collagen production in the skin when injected close to the surface, citing risks of lumpiness, unpredictability, and disproportionate results, especially when avoiding certain areas.

As a treatment for skin collagen stimulation, in my mind, it's a zero out of 10.

Botox [6:34]

• A brand name for neuromodulator injections (e.g., Xeomin, Dysport, Daxxify).
• Works by decreasing neurotransmitter transmission at the neuromuscular junction, preventing muscle expression.
• Effective for decreasing expression lines like the "11s" between the eyes and on the frontalus muscle.
• Rated 9 out of 10 for prevention and effectiveness, with a long history of studies and safety information (40-50 years).
• The only downside is its temporary nature, lasting 3-4 months and requiring re-treatment.

Botox I give a nine out of 10. As mentioned, it's great for prevention as well as the fact that it's effective and it's been around for a very very long time.

Oral Collagen [7:49]

• A popular supplement, often in hydrolyzed peptide form, used for skin health, fine lines, nail and hair growth, and potential joint benefits.
• Rated 4 out of 10 due to limited and small study research, making proper control groups difficult.
• Evidence shows mild improvement in fine lines and wrinkles, but it's unclear if this is due to hydration or other mechanisms.
• Physiologically, there's no clear way to understand how ingested collagen peptides directly impact skin.
• Not harmful, but miracles shouldn't be expected, and it shouldn't be the foundation of anti-aging.
• If used, it should be paired with Vitamin C, as it's required for collagen production.

Overall, not harmful, but don't expect miracles. And definitely don't lean on it as being your foundation of anti-aging.

Microneedling [9:16]

• Refers to cold microneedling without energy.
• Uses tiny needles to penetrate the skin and stimulate collagen through an injury response, thickening skin and decreasing lines.
• Rated 7 out of 10, especially for thin skin like the neck, and beneficial for texture, fine lines, wrinkles, acne scarring, and postsurgical scars.
• Requires continual use and multiple treatments, often starting with a package of 3-5, followed by maintenance every 6-12 weeks.
• Consistency is key for achieving benefits.

My rating 7 out of 10 when used in this format especially for skin that's thin like the neck skin etc. But overall I like it for texture fine lines and wrinkles and I also even like it for acne scarring and even postsurgical scars.

RF Microneedling [10:43]

• Combines microneedling with radiofrequency energy to heat the skin and stimulate more collagen production for potentially better results.
• Rated 6 to 7 out of 10 when used superficially (1-2 mm depth) to improve skin quality, yielding about 30% more collagen production.
• Rated 0 out of 10 when used for deep penetration (4-6 mm) and tightening as a replacement for surgery, due to potential damage to precious subcutaneous fat, difficulty with surgery, and limited, unimpressive results leading to disappointment.

When you're using it superficially or shallow, you're doing it to improve skin quality. I give it a 6 to 7 out of 10. It's a great treatment.

Chemical Peels [12:31]

• Treatments used to exfoliate and remove top layers of skin, revealing a fresh, bright new layer.
• Can reduce wrinkles, discoloration, and improve glow.
• Rated 7 out of 10 as a tried-and-true treatment that provides expectant results based on peel depth.
• Effective for improving fine lines, wrinkles, discoloration, and texture.
• Requires downtime, which can range from a few days to two or even four weeks, depending on the peel depth.
• Careful planning, including consultation on downtime and timing (generally outside summer months), is advised.

This is one of those treatments that's been around for a very, very long time. Tried and true. I give it a seven out of 10.

Red Light Masks [13:57]

• At-home devices designed to potentially stimulate collagen, decrease inflammation, and improve skin health.
• Rated 3 out of 10 due to soft evidence and being less significant as a collagen stimulator compared to established treatments like retinol or microneedling.
• Considered underwhelming and more trendy than effective.

In general, my rating is a 3 out of 10. Why I'm not convinced? Well, number one, the evidence is very soft. It really isn't that significant of a stimulator of collagen compared to the things that we already know that work so well.

Gua Sha [14:53]

• A facial massage technique using a stone or device, claimed to detoxify and sculpt the skin for a more youthful look.
• Rated 2 out of 10, considered overhyped.
• Any observed changes are temporary and short-lived.
• Does not stimulate collagen production through an injury cascade.
• May be enjoyable for self-care but not considered a serious treatment.

Why? Because I feel it's overhyped. First of all, any change that you see as temporary. And even if you do get a lifted effect, certainly it's not going to last.

UPF Clothing [15:44]

• Sun-protective clothing designed to block UVA and UVB light.
• Rated 8 to 9 out of 10 for regularly exposed areas like the neck, décolleté, arms, chest, and legs.
• Reduces sun damage, chances of skin cancers, and discolorations.
• The downsides are that it isn't fashionable and does not replace sunscreen; both should be used.

If you're going to be out in the sun on a regular basis, your neck, your decllete, your arms, your chest, your legs, etc. all are getting beat up by sun.

Hydrofacials [16:42]

• A treatment that deeply cleanses skin using vacuum, then applies a mild exfoliating chemical peel, and finally hydrates with serums.
• Rated 7 out of 10.
• Improves skin cleanliness, texture, and may stimulate some collagen from the mild peel.
• Essentially no downtime and low risk, great for maintenance and pre-event prep, giving a hydrated, "pretty glow."
• Needs to be done regularly, typically every four weeks.
• Described as a nice luxury treatment, slightly expensive, offering noticeable but not dramatic results.

Overall, I would say it's a nice luxury treatment. It's a little bit on the expensive side relative to maybe even a standard facial, but in the end, it does give some results even though they're not dramatic.