Everything You’ve Ever Wanted to Ask a Top L.A. Dermatologist

Dermatologist Ava Shamban is the kind of person you also want to have as a best friend. She’s fiercely loyal, always game for a laugh and gives excellent botulinum toxin injections (or so I’ve heard…). Barely two weeks after opening of her new Pacific Palicades treatment center, Skin X Five (like multiplication: Skin times Five), she took a few minutes to fill us in (pardon the pun!) on everything she’s excited about.

You’re one of the most respected dermatologists in the business. You’re involved in lots of skin treatment trials, you’re on the short list of dermatologists we editors call. Now, you’ve taken what you’ve learned and incorporated it into this one-stop treatment center. Why was that important to have it all under one roof? The underlying premise is maintenance. Even though our tagline is “Correct, protect, love,” the emphasis is about taking care of problems before they happen or right as they’re just beginning to happen. Our treatments range from the lightest, which is a peel, then the hydra facial, then toxin, then “YAG” laser, which we use with a few different wavelengths, and the fifth is radio-frequency. So they’re all basically the best in class of those categories. Then we thought what if you wanted to do everything at once? So we call that the “Full Picture,” which is everything but the toxin. And that’s what everybody’s booking!

I’m not surprised. Well, I guess I was, considering the cost. It’s $750, which is reasonable considering what you’re getting, but I was still surprised. We already have one women who came in and loved it so much, she booked a series. The next most popular are the peels.

What’s the downtime? None. That’s the beauty of it. The idea is no downtime, but do these treatments more frequently. It’s based on the observation that frequent low-energy treatments are almost as effective as a single isolated treatment that’s much more intense and requires significant downtime. It will change the way you age, keeping your skin more fit – the same way that regular ballet practice keeps your muscles toned. Also, start early. I say to my patients, ‘What you do today affects how you look tomorrow.’ I used to have patients who were around 40-45 come in and have Thermage [radiofrequency skin tightening], and maybe a little bit of collagen [injections] and I’d think, ‘What are you guys doing here? I hardly see signs of aging.’ I was operating on the older concept that we don’t treat any problems until you see them. But these people were the smart ones! They’re now in their sixties and their necks are tight, their jawlines are crisp, their cheeks are plump.

Nice… So I created our menu in a problem-solution format. Your irregular texture looks bumpy? The peel fixes that. The Hydrafacial is where they push the antioxidants deeper in the skin after you suck out the pores. And the third is toxin. It’s really interesting about the frown. Have we talked about the frown before?

I’m not sure… There are three reasons to treat the frown. One, the negative feedback that comes with it. You actually feel depressed or anxious when you frown, and there’s a lot of data to support that. Studies have shown that when you treat a frown with toxin, that person’s mood gets better!

Well, mine certainly would! It’s almost as good, or equivalent to an antidepressant, in fact. I can send you the article. Peer reviewed! The second is the non-verbal communication. If a person is frowning, you don’t know if they’re angry with you or depressed. It’s the basis of Resting Bitch Face. The third reason to treat it, of course, is just wrinkles. Or brow dropping. Our fourth treatment, the “YAG” laser, does many different things. It’s been shown to work on irregular pigmentation, fine lines and wrinkles, acne, acne scars. It’s a version of what they’re using at Skin Laundry for cleaning your face, but this is a little stronger. And the fifth is radio-frequency.

Does that still hurt? It’s a lot more tolerable. Many years ago, a patient came in and had the area around her mouth resurfaced. At the same time, I did a radio-frequency treatment on the rest of her face. She came back the next day and she was so pleased with the early results of the resurfacing, that she wanted her entire face resurfaced. When I did the procedure, I saw the skin where she had the radio-frequency done was dramatically stimulated, and she healed faster. That observation played into my plan because you are also stimulating the skin on so many different layers at the same time. So there’s a method behind my madness. People come in from being on location and tell me they have to walk the red carpet tomorrow. It’s good to know what I can get away with so they can go pick up their statuette the next day.

In the world of cosmetic dermatology, what are you most excited about? A couple things, like the Silhouette Suture Lift. They’re not calling it the “Thread Lift” anymore. They say it’s not a thread. I’ve done a handful of them now and people really do get lifted. There’s no data for what the longevity results, but it really looks great and it’ll be nice to add in to the fillers. Because the stiffer fillers do have some lift, too.

Is this an in-office procedure? Yeah, but it’s not a “lunch time” one when you can go back to work afterwards. I would say if you did at the end of the day, you’re okay the next day. You have to have local anesthetic.

How does it work? A single entry point is identified in the middle of the cheek and local anesthetic is injected at that point. The one needle is then inserted into that entry point, then threaded just below the skin to exit at the smile line. The other needle is inserted into the same entry point but in a different direction, toward the hair line, and that exit point is at the hair line. So, the thread runs from the hair line to the smile line in an uninterrupted fashion. Then, you trim the needle off and there are tiny cones that are strung on the suture thread like Christmas lights. As you sew the thread between the entry and the exit points, the cones grab onto connected tissue just below the dermis and they pull the skin up like tiny little anchors.

Have you had this done to yourself? I haven’t had it, no. I have to have [Chicago plastic surgeon] Julius Few do it.

Well, that was one of my questions, but I’ll get to that later. So, clearly, you’re into this. I thought the results were great. I’m all about safety, and so this safe since it’s just below the skin. With the old original threads, they went deep, trying to hook on to the muscles, the ligaments, forget about that. That was blind, that was ridiculous. This is just below the skin, and so you’re taking advantage of connective tissue that’s there. I think this could be really great.

Anything for the body? I think the cellulite stuff is looking better. There’s the ThermiRF, which can break up the fibrous brands in with cellulite. Cellfina looks tedious, but people are getting nice results. For tissue tightening in the arms and legs of older women whose fat has been chewed up by the sun, a very, very low dose of Sculptra is really interesting.

Anything you think is a dud? Some of the fat melters. Liposonix is a dud…

So do you fall into the fat melting or fat freezing camp? We have the dual [fat freezing] Coolsculpt in my Beverly Hills office and I think it’s incredible. It’s shockingly, stunningly effective. The Sculpsure, which is the laser, I had that one done. It worked, but the problem with it was the hand pieces, which you have to hook into this belt thing, so it’s hard to get as comprehensive an area. It’s one of those machines where it works, but it’s early, so they have to figure that problem out. I had a little shelf issue. The fat really melted, but then I had a ridge. But the technology’s good. It happens a lot with these machines. They come out but they take a couple years to mature.

What do you tell people who complain about their under-eye bags? Or what do you tell them can and cannot be done? It reminds me of a mutual friend of ours, who just the other night at dinner said to someone, “You cannot put anything under the eyes because it could make you go blind! Doctors do it, but they’re not supposed to!” But she’s wrong! Actually, the risk is actually in the nasolabial fold. Because of the angular artery, which doesn’t run under the eye. Anyway, if the skin is loose enough you can tighten it with some radio-frequency. Also, we have a hand piece called ResurFx, which is like a Fraxel. That works pretty well for that crepe-y skin. Sometimes if you look at a patient from the side and not too full, then you can inject in the groove there, the tear tough, just so it looks smooth again, and that works well. But if it’s a really big pillow there, then you’re looking at surgery. Years ago, when they first started using the dioxycholic acid, which [fat dissolving injectable, usually used on double chins] Kybella came directly from, people were injecting it right under the eyes. It looked pretty good, but people got really swollen and then you had the risk of losing your vision. So that went away! You know, all this business of letting things get out of hand, then, Ok! Time to see the surgeon!

It’s kind of like managing your finances over time. It’s the same as managing your mouth. You don’t take care of it at all, then you show up at the dentist and you’re shocked that you have ten cavities. It’s the same with skin care.

From where I sit, everyone points to beneath their eyes. Maybe because most of my friends are now in their forties. Do you think eye creams work? I think they can be effective, but you need retinol. That said, if you’re seeing bags, then your skin is already kind of loose and it’s sort of late. It depends on how lasered up you want to get. If you do an ablative laser, like a C02 (and we’re not talking Fraxel here), you can press that fat pad back down.

Oh, gross! The face is like a baseball mitt. It’s got all these fat pads all over it, some superficial, some deep, so if your mid-face fat pad starts to slide down, then you’re going to see your under-eye fat pad. It’s not a straightforward answer. It’s something that needs to be evaluated. But what you’re really doing with the eye cream is supporting the delicate skin around the eye and under the eye.

I’ve never found one that works enough for me to be compliant. I use my prescription retinoid all the way up to my lash line, and then I put an eye cream on top of it. Because studies have shown that you get less irritation from retinoids if you use them with a moisturizer. And it doesn’t reduce efficacy. But it takes time. Over a year, they did this treatment on forearms of people aged 45-70. Over time you could see those tiny etched wrinkles went away.

Got any skin care discoveries yourself? Yes! I get this retinoid dermatitis around my neck and mouth. I used to use glycolic in the morning and retinoid at night, but I discovered Eucerin with alpha hydroxy acid and the peeling and redness went away. It was a big discovery.

The neck and the under eye areas, man…the holy grail! What do you think is the unsung hero? I think it’s the joint effort of doing it all together frequently, which brings me back to our Skin X Five. What’s the best way to change the way you age, and to make maturing not such a devastating process where you look at your face in the mirror and you’re like ‘Argh!’ It’s everything. It’s fitness, what you eat, sleep and skin care, skin care and some procedures.

What are you excited about that’s coming down the pike? I think the Pico technology. It heats is like an atomic bomb. It goes through the skin and there’s like this mini explosion. So I think that technology in terms of rejuvenation is very interesting.

Who do you go to for work on yourself? Oh goodness, I’m like the cobbler’s children [who never have shoes]. I go to one of the nurse practitioners in my office once in a while. And then if I’m at a [dermatological] meeting, at the end of the meeting, I’m like, “Oh! Here we all are. Hey, expert from XY company from XY city.” It’s kind of cool because I never have the same expert treat me twice. And I always sort of yell at them. They’re all afraid of me, well, not really—

You’re like a sister. Nobody tries to do anything crazy to my face.

If you ever had a facelift, who would you go to? I’d probably go to Dr. Robert Hutcherson here in L.A. There’s good people out there. There’s Ellen Marmur in New York. And I like Patrick Sullivan in Rhode Island. He does really nice work. There are a lot of people who don’t have a “name” who are really good. Like Jonathan Hoenig. I think he started out as an ophthalmologist, then he did oculoplasty, then he did head and neck facial plastic. He’s an outstanding surgeon, he has some of the best hands.

Thanks for these. Okay, are you ready for the fun ones? What’s your first beauty memory? It’s actually surgical. When I got my ears pierced. I’d just started 7th grade. Well, before that, getting glitter in my hair when I was eight or nine. I had a pixie cut and they put glitter in. I thought it was the coolest thing ever. I went to the playground and I felt like a fairy princess.

What was your worst beauty blunder? Bain de Soleil. Putting that orange gel on. If I smell it now, I’m immediately back at the beach. My mother told me, “You shouldn’t tan!” And I tan really nicely. So maybe when I’m in my 70s, I can lay out and get a tan…I turn such a pretty color of brown. And now I’ve got spots on my arms! That and then watching all my patients have Thermage every four months, and I’m like, ‘I had one last year.’ That was stupid. My patients knew to come in regularly. This was back in the day when it hurt and I thought, ‘Wow, this is great, but I don’t want to do it again.’ But my patients who kept doing it, their necks are super tight.

So it’s a lot of coulda, shoulda, woulda, but it’s also a little ‘Do as I say, not as I do.’ It’s also me realizing that when I work on people in their 60s, who’ve never had anything done, beautiful women. You can never get them back to the same place as the woman who came in at 45 or 50 doing it. It’s almost impossible.

Who do you think is looking great over 40? I think Sandra Bullock looks good, and she’s over 50.

Which beauty product do you not ‘get’? Stem cell cream. Seriously? Putting a stem cell into skin is like trying to get an elephant through a keyhole. Our skin is designed not to let big structures in.

Which beauty trend do you not get? Tattoos. At least if you’re wearing jewelry, you can change your jewelry. The other thing I can’t stand is exaggerating facial features. And then finally, does everyone have to look the same? Does everyone look like Kim Kardashian?

What are you currently obsessed with? Yoga. I have this new instructor, Matt Hodges at Maha Yoga. I have a bad back and I’ve been told by the surgeon that I’m just shy of needing to put a plate between my bones and my back, because it’s unstable from a herniated disk. It turns out that using all these postures and having someone there to help you hold the position, it’s made my back pain go away. It’s all about fitness. Taking 10,000 steps, sleeping as much as I can and eating well. All the basics plus preventative skin care and treatments.

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