Beverly Hills plastic surgeon Dr. Sheila Nazarian says much of her practice now involves advising patients on skincare rather than performing surgery, and that many of her happiest patients never go under the knife at all.
Nazarian, founder of Nazarian Plastic Surgery and NazarianSkin, said fine lines, wrinkles, age spots and loss of skin elasticity result from thousands of small injuries that build up over decades. She named UV damage, inflammation, pollution, declining collagen production, hormonal changes, poor nutrition and unsuitable skincare products as contributing causes.
She said patients are increasingly requesting treatments that avoid months of recovery, seeking gradual, natural improvements that friends notice without being able to identify the cause. Nazarian outlined five treatments she typically recommends.
Collagen stimulation
Collagen is the most abundant protein in the body and forms the structural basis of skin, bones, tendons, ligaments and muscles, according to Nazarian. She said people lose roughly one percent of their collagen every year after their twenties, with the loss accelerating during menopause, after weight loss and following prolonged illness.
Nazarian said a newer radiofrequency technology stimulates multiple layers of tissue, including the fibromuscular layer of the face that contains connective fibers, something earlier collagen treatments did not reach. She said the goal is to help patients look like themselves five or ten years earlier, with minimal downtime. The treatment costs between $1,200 and $3,500 per session, she said.
Peptides
Nazarian said peptides can stimulate the growth of collagen and elastin, a protein that gives tissue its elasticity. Leading injectable peptides cost between $250 and $450 a month, she said, and practitioners including herself will ship them directly to patients for home injection, though she said peptides should always be sourced through certified medical professionals.
Peptide-based serums, which she said function similarly to traditional collagen-stimulating antioxidant serums, start at around $25.
Exfoliation
Nazarian said dead skin cells accumulate over time, dulling the complexion, clogging pores and preventing active ingredients from penetrating the skin. She recommends glycolic acid, an alpha hydroxy acid she described as one of the most studied for improving skin texture, brightness and fine lines.
Glycolic acid pads range from $10 to over $100 per package depending on strength and grade, she said.
Antioxidant protection
Nazarian said most people understand sunscreen but few appreciate how much oxidative stress contributes to aging. She said pollution, UV exposure, smoke and unstable molecules called free radicals gradually break down collagen and elastin, and that oxidative stress is thought to play a role in cancer, Alzheimer's disease and heart disease.
She recommends antioxidant treatments including vitamin C, vitamin B3, green tea extract, resveratrol and ferulic acid, priced between $100 and over $250 depending on strength and brand.
Laser lightening
For pigmentation issues such as sun damage, melasma, freckles, acne discoloration and age spots, Nazarian said she often recommends laser treatment rather than brightening creams. She said lasers target excess melanin to break down pigment and also stimulate collagen growth to even out skin tone.
Nazarian said laser treatments are generally safe but not risk free. The heat can overstimulate melanin-producing cells and worsen dark spots, she said, or destroy pigment cells and cause pale or white patches, with the risk higher in people with darker, more melanin-rich complexions. Prices range from about $150 to more than $1,500 per session depending on the treatment and practitioner, she said.
Nazarian said none of the five recommendations are about chasing perfection, and that the biggest transformations she sees are not dramatic makeovers but patients who commit to a consistent skincare routine, stimulate collagen, protect their skin daily and choose treatments that work with their biology.
