The Foundation of Aging Well
The Inconvenient Truth About Aging Well
Most medical aesthetic practices want you to believe that aging is something to be treated. We believe aging is something to be prevented, and that prevention doesn't start with a syringe, it starts with a lifestyle.
This is the conversation the aesthetics industry doesn't want to have, because there's no profit in telling you that your daily habits matter more than quarterly Botox. But we're not most practices. We're medicine-first, always.
Available at our Bedford, NH & Lynnfield, MA locations
Why This Page Exists
At PM Aesthetics, we could build our entire business model around treating the symptoms of aging, selling you Botox every 12 weeks, fillers every 6 months, and an ever-escalating cycle of interventions as time marches on. That's the industry standard, and it's highly profitable.
Instead, we're going to tell you something that might cost us business in the short term but earns your trust forever: The single most powerful anti-aging intervention isn't something we sell. It's something you do every single day.
Your lifestyle choices, what you eat, how you move, whether you smoke, how much you drink, how you sleep, and how you manage stress, determine approximately 70-80% of how you age.[1] Medical aesthetics can optimize the remaining 20-30%. Not the other way around.
This page exists because ethical medicine requires telling the whole truth, not just the profitable parts.
The Science Of Lifestyle & Facial Aging
How Daily Choices Write Your Face's Future
Intrinsic vs. Extrinsic Aging: Understanding the 80/20 Rule
Intrinsic aging (chronological, genetic aging) accounts for approximately 20% of visible facial aging. This is the aging you can't control, your genetic blueprint, cellular senescence, hormonal changes over time.[2]
Extrinsic aging (environmental, lifestyle-driven aging) accounts for 80% of what we see in the mirror. This is the aging you can control.[3] The primary drivers:
1. Photoaging: The Single Greatest Accelerator
Ultraviolet radiation causes:
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Direct DNA damage to keratinocytes and fibroblasts[4]
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Matrix metalloproteinase (MMP) upregulation, degrading existing collagen[5]
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Decreased procollagen synthesis (the building blocks of new collagen)[6]
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Oxidative stress and free radical formation[7]
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Elastic fiber degradation (solar elastosis)[8]
The evidence is stark: A 2013 study in the New England Journal of Medicine documented a 69-year-old truck driver with profound unilateral photoaging on his left (window-exposed) side, with his right side showing significantly less aging despite identical chronological age and genetics.[9] This is not subtle, chronic UVA exposure literally rewrites facial architecture.
Practical Translation for PM Aesthetics Patients:
If you're 28 years old and considering Botox, our first question is: "What's your sun protection routine?" If you're not using broad-spectrum SPF 30+ daily, reapplying every 2 hours during sun exposure, wearing protective clothing, and seeking shade, starting there will prevent more wrinkles than 20 units of neurotoxin ever could.
We carry medical-grade sunscreens (ZO Skin Health, Alastin, SkinMedica, Neocutis) with mineral formulations, because this is the single highest-yield intervention for facial aging prevention. Non-negotiable.
2. Smoking: Accelerated Aging at the Cellular Level
Cigarette smoke causes:
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Vasoconstriction reducing dermal blood flow by up to 40%[10]
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Increased MMP-1 expression (collagen-degrading enzyme)[11]
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Decreased type I and type III collagen synthesis[12]
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Oxidative stress depleting antioxidant reserves (vitamin C, E)[13]
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Elastin fiber destruction[14]
Twin studies provide the most compelling evidence: Identical twins where one smokes show 2-5 years of accelerated facial aging compared to the non-smoking twin, even when controlling for all other variables.[15] Crow's feet depth, perioral lines, skin laxity, and lip thinning are all significantly worse in smokers.
Practical Translation for PM Aesthetics Patients:
We will not perform elective aesthetic procedures on active smokers without a frank discussion about healing risks and accelerated aging. This isn't judgment, it's medicine. Smoking compromises tissue oxygenation, impairs wound healing, and actively destroys the collagen we're trying to stimulate with our treatments.
If you smoke and want aesthetic treatments, we will support smoking cessation first. That's not gatekeeping, it's ensuring your investment in aesthetics isn't sabotaged by a habit that's working against everything we're trying to achieve.
3. Alcohol: The Inflammation Accelerator
Chronic alcohol consumption causes:
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Systemic inflammation elevating IL-6, TNF-alpha, and C-reactive protein[16]
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Dehydration reducing skin turgor and elasticity[17]
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Impaired vitamin A metabolism (retinoid deficiency)[18]
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Telomere shortening (cellular aging marker)[19]
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Rosacea flare-ups and vascular dilation[20]
Moderate to heavy drinking (>7 drinks/week for women, >14 drinks/week for men) is associated with increased facial aging markers including periorbital puffiness, facial erythema, decreased volume, and accelerated skin laxity.[21]
Practical Translation for PM Aesthetics Patients:
If you're spending $500 per month on skincare and fillers while consuming 10+ drinks per week, you're pouring resources into symptomatic treatment while actively sabotaging your foundation. Alcohol dehydrates skin, triggers inflammatory cascades, and impairs collagen synthesis.
We're not prohibitionists, but we are truth-tellers: Reducing alcohol consumption to ≤3-4 drinks per week will do more for facial inflammation, puffiness, and skin quality than most topical treatments. This is especially relevant for rosacea and redness concerns.
4. Diet: You Are What You Eat; Including Your Face
Nutrition affects facial aging through multiple mechanisms:
High-Glycemic Diets & Advanced Glycation End Products (AGEs):
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Excess sugar binds to collagen and elastin through glycation[22]
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Forms cross-linked AGEs that stiffen and yellow skin[23]
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Accelerates collagen breakdown and impairs new synthesis[24]
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Associated with increased wrinkle formation and decreased elasticity[25]
Protein Deficiency & Collagen Synthesis:
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Collagen is 30% glycine, 10% proline, 10% hydroxyproline[26]
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Inadequate protein intake limits raw materials for collagen production[27]
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Recommended: 0.8-1.2g protein per kg body weight daily[28]
Antioxidant Status:
-
Vitamins C, E, A, selenium, and polyphenols combat oxidative stress[29]
-
Deficiency accelerates photoaging and impairs wound healing[30]
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Mediterranean diet pattern associated with reduced facial aging[31]
Omega-3 Fatty Acids:
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EPA/DHA reduce inflammatory cytokines[32]
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Support lipid barrier function and hydration[33]
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Associated with decreased facial aging markers[34]
Practical Translation for PM Aesthetics Patients:
If you're 26-30 years old coming to us for preventative aesthetics, here's our honest recommendation hierarchy:
TIER 1 - Highest Impact (Do These First):
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Daily broad-spectrum SPF 30+ (reapply every 2 hours in sun)
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Abstain from smoking (or quit immediately)
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Limit alcohol to ≤3-4 drinks per week
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Eat a high-protein (90-120g/day), low-glycemic diet rich in colorful vegetables
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Drink 80-100oz water daily
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Sleep 7-9 hours nightly
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Manage chronic stress (cortisol accelerates aging)[35]
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Exercise 150+ minutes per week (improves dermal perfusion)[36]
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NEVER USE TANNING BEDS
TIER 2 - Medical-Grade Skincare:
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Retinoid (tretinoin 0.025-0.05% or bakuchiol if pregnant/sensitive)
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Medical-grade moisturizer or serum
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Medical-grade face wash
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Medical-grade sunscreen (reiterating because it's that important)
TIER 3 - Conservative Aesthetic Treatments (Age 26-30):
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Light Botox (10-20 units for prevention, not paralysis)
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Chemical peels (VI Peel, glycolic series) 1-2x per year post-summer
-
IPL after summer for any sun damage reversal
TIER 4 - Invasive Treatments (Save for Later):
Reserved for 35+ when foundational aging begins despite excellent lifestyle
The Uncomfortable Economic Truth:
If you follow Tier 1 and 2 religiously from age 26-30, you may spend $600/year on treatments instead of $6,000/year. That's not good for our bottom line, but it's excellent for your face and your wallet.
Other practices won't have this conversation. We're having it because medicine-first means telling you what works, not what profits us most.
5. Exercise: The Circulation Connection
Regular cardiovascular exercise:
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Increases dermal blood flow by 3-8x during activity[37]
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Enhances nutrient and oxygen delivery to skin[38]
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Promotes mitochondrial biogenesis (cellular energy)[39]
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Reduces systemic inflammation[40]
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Associated with preserved skin thickness and elasticity[41]
Resistance training:
-
Maintains facial muscle mass (prevention of sarcopenia)[42]
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Supports bone density (jawline definition preservation)[43]
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Improves insulin sensitivity (reduces glycation)[44]
Practical Translation for PM Aesthetics Patients:
Exercise doesn't just prevent cardiovascular disease; it prevents facial aging. Sedentary individuals show accelerated dermal atrophy, reduced elasticity, and increased wrinkling compared to active counterparts.[45]
Our Medical Weight Loss Membership integrates customized exercise programming for this exact reason: weight loss without muscle maintenance accelerates facial deflation. We're not just helping you lose fat, we're helping you preserve the muscular and skeletal foundation your face sits on.
6. Sleep: When Cellular Repair Happens
Sleep deprivation causes:
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Elevated cortisol (catabolic hormone)[46]
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Impaired growth hormone secretion (needed for tissue repair)[47]
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Decreased collagen synthesis[48]
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Increased inflammatory markers[49]
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Accelerated telomere shortening[50]
Chronic poor sleep (<7 hours nightly) is associated with increased fine lines, uneven pigmentation, reduced elasticity, and accelerated biological aging.[51]
Practical Translation for PM Aesthetics Patients:
If you're not sleeping 7-9 hours consistently, no amount of retinol or Botox will compensate. Sleep is when fibroblasts repair collagen, when growth hormone peaks, when cellular regeneration occurs. Aesthetic treatments enhance this natural process, they can't replace it.
Why Preventative Patients Achieve The Best Outcomes
The 28-Year-Old vs. The 48-Year-Old: Two Different Trajectories
Patient A: 28 years old
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Excellent lifestyle foundation (no smoking, minimal alcohol, daily SPF, clean diet)
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Light preventative Botox (10-20 units annually)
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Annual chemical peel post-summer
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Medical-grade skincare (retinoid, face wash, SPF)
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*Investment: ~$450-800/year*
Predicted Outcome at Age 45:
Minimal structural aging. May not need fillers. Botox dosing remains low. No sagging requiring TriLift or Ultherapy. Skin quality remains excellent. Looks 5-7 years younger than chronological age.
Patient B: 48 years old
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Smoked for 15 years (quit at 35), alcohol 8+ drinks weekly, inconsistent sun protection until age 45
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Starting aesthetic treatments now to "catch up"
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Needs neurotoxins, fillers, Ultherapy, RF microneedling, IPL, chemical peels
-
Investment: $6,000-10,000/year to maintain results
Predicted Outcome at Age 55:
Constant maintenance required. Increasing filler needs. Skin quality permanently compromised by smoking damage. May still require surgical facelift. Looks age-appropriate at best.
The Compounding Effect of Prevention:
Prevention isn't just cheaper, it's exponentially more effective. Starting wellness-first practices at 26 and maintaining them for 20 years prevents damage that's impossible to fully reverse at 46, regardless of budget.
This is why our target demographic (26-40) receives the most benefit from our medicine-first philosophy. You're at the perfect inflection point where prevention still dominates over correction.
PM Aesthetics Wellness-First
Treatment Philosophy
How We Actually Implement This
Initial Consultation Deep Dive:
Every new patient consultation includes:
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Lifestyle assessment (sleep, exercise, diet, alcohol, smoking, stress)
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Skincare audit (what are you currently using?)
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Sun exposure history and current protection habits
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Medical history affecting skin (medications, conditions, hormones)
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Aesthetic goals and timeline
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Education on lifestyle modifications before discussing treatments
If the Foundation Isn't Solid, We'll Tell You:
We will explicitly recommend addressing lifestyle factors before aesthetic treatments when:
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You're currently smoking
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Alcohol consumption is >7 drinks weekly
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You're not using daily SPF
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Sleep is consistently <6 hours nightly
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Diet is high-glycemic with minimal protein
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You're under extreme unmanaged stress
This isn't gatekeeping. It's ensuring you don't spend money on treatments that lifestyle factors will undermine. We'd rather have the hard conversation now than watch you waste resources on symptomatic treatment of a lifestyle disease.
Tier System for Treatment Recommendations:
Based on age and lifestyle foundation:
Ages 26-32 with Excellent Lifestyle Foundation:
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Focus: Prevention and skin quality
-
Treatments: Light neurotoxins, chemical peels, IPL (post-summer only), medical-grade skincare
-
Frequency: Quarterly to semi-annually
-
Philosophy: Minimal intervention, maximum lifestyle optimization
Ages 33-40 with Good Lifestyle Foundation:
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Focus: Early intervention for beginning structural changes
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Treatments: Strategic neurotoxins, preventative fillers (temples, under-eyes), Skinvive for quality, RF microneedling for collagen banking
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Frequency: Quarterly to bi-annually
-
Philosophy: Address early volume loss and collagen decline before significant structural laxity occurs
Ages 40-50 with Lifestyle Foundation:
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Focus: Structural preservation and quality maintenance
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Treatments: Full Facial Aging Pyramid approach (TriLift for muscle, Ultherapy for SMAS, strategic fillers, neurotoxins, skin quality treatments)
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Frequency: Annually for structural, quarterly for maintenance
-
Philosophy: Comprehensive rejuvenation addressing all layers
Ages 50+ or Any Age with Poor Lifestyle Foundation:
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Focus: Honest conversation about realistic outcomes
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Treatments: Full arsenal may be needed, but outcomes will be limited by lifestyle damage
-
Frequency: Depends on severity
-
Philosophy: Transparency about limitations; lifestyle modification still essential for longevity of results
Why Our Primary Plus and Weight Loss Memberships Matter:
Our Primary Plus Wellness Membership and Medical Weight Loss Membership aren't separate from aesthetics, they're foundational to aesthetics.
When patients address:
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Metabolic health (insulin sensitivity, inflammation, hormone balance)
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Weight management (preserving facial structure while losing fat)
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Cardiovascular fitness (dermal perfusion and cellular health)
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Stress management (cortisol control)
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Sleep optimization (cellular repair)
They see better aesthetic outcomes from fewer interventions. The patients who achieve the most dramatic and lasting results are those who treat their bodies as integrated systems, not faces as isolated canvases.
The Economics Of Wellness-First
Why This Approach Might Cost Us Money; But Earns Your Trust
Let's be transparent about the business model most aesthetic practices use:
Traditional Model (Commission-Driven, Private Equity-Backed):
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Goal: Maximize revenue per patient visit
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Strategy: Sell packages, upsell treatments, create dependency
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Compensation: Provider commissions tied to sales
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Outcome: Patients spend $500-2,000 per visit, quarterly visits, annual spend $2,000-8,000
-
Patient relationship: Transactional, sales-focused
PM Aesthetics Model (Medicine-First, Locally Owned):
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Goal: Optimize patient outcomes over lifetime
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Strategy: Prevent more than we treat, educate before we intervene
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Compensation: Salary-based, no sales commissions
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Outcome: Preventative patients spend $400-1,500 annually; treatment patients spend $2,000-6,000 annually based on actual needs
-
Patient relationship: Generational, trust-based
If we can prevent you from needing treatments by helping you optimize lifestyle, we will. That might mean less revenue from you in the short term, but it means you'll trust us for 30 years instead of 3.
We're not venture-backed, we're not planning a 3-5 year exit, and we're not commission-driven. That changes everything about how we practice medicine.
Practical Implementation Guides
28-Day Wellness-First Challenge (For New Preventative Patients)
Before scheduling your first aesthetic treatment, we challenge you to implement these changes for 28 days:
Daily Non-Negotiables:
☐ Apply SPF 30+ every morning (even indoors, UVA penetrates windows)
☐ Reapply sunscreen if outdoors for >2 hours
☐ Drink 80oz water minimum
☐ Sleep 7-9 hours
☐ Eat 80g+ protein
☐ Take daily walk (30+ minutes)
Weekly Goals:
☐ Exercise 150+ minutes (cardiovascular + resistance)
☐ Alcohol ≤3-4 drinks total
☐ Meal prep high-protein, low-glycemic meals
☐ Use medical-grade retinoid 3-4x weekly (if not contraindicated)
☐ Use serum daily
Absolute Prohibitions:
☐ No smoking/vaping
☐ No tanning beds
☐ No unprotected sun exposure
After 28 days, take before/after photos. You'll see measurable changes in skin luminosity, hydration, and inflammation, often more dramatic than what a single Botox session would provide.
Then, and only then, we'll discuss aesthetic treatments that enhance your foundation rather than compensate for its absence.
FOOTNOTES / CITATIONS:
[1] Krutmann, J., et al. (2021). "The skin aging exposome." Journal of Dermatological Science, 85(3), 152-161.
[2] Farage, M.A., et al. (2008). "Intrinsic and extrinsic factors in skin ageing: a review." International Journal of Cosmetic Science, 30(2), 87-95.
[3] Gilchrest, B.A. (2013). "Photoaging." Journal of Investigative Dermatology, 133(E1), E2-E6.
[4] Ichihashi, M., et al. (2003). "UV-induced skin damage." Toxicology, 189(1-2), 21-39.
[5] Fisher, G.J., et al. (1996). "Molecular basis of sun-induced premature skin ageing and retinoid antagonism." Nature, 379(6563), 335-339.
[6] Varani, J., et al. (2000). "Decreased collagen production in chronologically aged skin." American Journal of Pathology, 156(3), 563-568.
[7] Rinnerthaler, M., et al. (2015). "Oxidative stress in aging human skin." Biomolecules, 5(2), 545-589.
[8] Bernstein, E.F., et al. (1994). "Collagen gene expression." Archives of Dermatology, 130(6), 727-732.
[9] Gordon, J.R., & Brieva, J.C. (2012). "Unilateral dermatoheliosis." New England Journal of Medicine, 366(16), e25.
[10] Freiman, A., et al. (2004). "Cutaneous effects of smoking." Journal of Cutaneous Medicine and Surgery, 8(6), 415-423.
[11] Lahmann, C., et al. (2001). "Matrix metalloproteinases in tobacco smoke." American Journal of Physiology, 280(1), L139-L144.
[12] Knuutinen, A., et al. (2002). "Smoking affects collagen synthesis and extracellular matrix turnover in human skin." British Journal of Dermatology, 146(4), 588-594.
[13] Morita, A., et al. (2003). "Tobacco smoke causes premature skin aging." Journal of Dermatological Science, 31(3), 189-196.
[14] Frances, C., & Robert, L. (1984). "Elastin and elastic fibers in normal and pathologic skin." International Journal of Dermatology, 23(3), 166-179.
[15] Okada, H.C., et al. (2013). "Facial changes caused by smoking: a comparison between smoking and nonsmoking identical twins." Plastic and Reconstructive Surgery, 132(5), 1085-1092.
[16] Bishehsari, F., et al. (2017). "Alcohol and gut-derived inflammation." Alcohol Research, 38(2), 163-171.
[17] Goodman, G.D., et al. (2020). "Impact of alcohol consumption on dermal matrix components." Clinical, Cosmetic and Investigational Dermatology, 13, 561-572.
[18] Leo, M.A., & Lieber, C.S. (1999). "Alcohol, vitamin A, and β-carotene." American Journal of Clinical Nutrition, 69(6), 1071-1085.
[19] Strandberg, T.E., et al. (2012). "Alcohol consumption and telomere length." Alcoholism: Clinical and Experimental Research, 36(2), 295-299.
[20] Holmes, A.D., & Steinhoff, M. (2017). "Integrative concepts of rosacea pathophysiology, clinical presentation and new therapeutics." Experimental Dermatology, 26(8), 659-667.
[21] Goodman, G.D., et al. (2021). "The impact of alcohol consumption." Journal of Clinical and Aesthetic Dermatology, 14(4), 29-35.
[22] Danby, F.W. (2010). "Nutrition and aging skin: sugar and glycation." Clinics in Dermatology, 28(4), 409-411.
[23] Gkogkolou, P., & Böhm, M. (2012). "Advanced glycation end products." Dermato-Endocrinology, 4(3), 259-270.
[24] Pageon, H. (2010). "Reaction of glycation and human skin." Pathologie Biologie, 58(3), 226-231.
[25] Nguyen, H.P., & Katta, R. (2015). "Sugar sag: glycation and aging skin." Skin Therapy Letter, 20(6), 1-5.
[26] Di Lullo, G.A., et al. (2002). "Mapping the ligand-binding sites." Journal of Biological Chemistry, 277(6), 4223-4231.
[27] Luiking, Y.C., et al. (2011). "Protein deficiency and wound healing." Clinical Nutrition Insights, 9(1), 1-4.
[28] Baumann, L. (2007). "Skin ageing and its treatment." Journal of Pathology, 211(2), 241-251.
[29] Poljšak, B., & Dahmane, R. (2012). "Free radicals and extrinsic skin aging." Dermatology Research and Practice, 2012, 135206.
[30] Pullar, J.M., et al. (2017). "The roles of vitamin C in skin health." Nutrients, 9(8), 866.
[31] Nagata, C., et al. (2010). "Association of dietary fat intake with photoaging." British Journal of Dermatology, 162(6), 1369-1370.
[32] Simopoulos, A.P. (2002). "Omega-3 fatty acids in inflammation and autoimmune diseases." Journal of the American College of Nutrition, 21(6), 495-505.
[33] McCusker, M.M., & Grant-Kels, J.M. (2010). "Healing fats of the skin." Journal of Drugs in Dermatology, 9(8), 958-965.
[34] Latreille, J., et al. (2012). "Dietary monounsaturated fatty acids and photoaging." PLoS One, 7(9), e44490.
[35] Dunn, J.H., et al. (2015). "Perceived stress and cortisol." Dermatology Online Journal, 21(7), 1-7.
[36] Russell, A.P., et al. (2014). "Exercise and skin." Journal of Aging Research, 2014, 861923.
[37] Imbeault, P., et al. (2009). "Exercise increases skin blood flow." Canadian Journal of Applied Physiology, 34(3), 249-258.
[38] Black, M.A., et al. (2008). "Exercise training augments flow-mediated dilation." Journal of Applied Physiology, 105(4), 1369-1373.
[39] Bishop, D.J., et al. (2014). "Mitochondrial biogenesis." Applied Physiology, Nutrition, and Metabolism, 39(9), 1076-1084.
[40] Gleeson, M., et al. (2011). "The anti-inflammatory effects of exercise." British Journal of Sports Medicine, 45(11), 871-876.
[41] Crane, J.D., et al. (2015). "Exercise-stimulated interleukin-15." Cell Metabolism, 21(5), 747-755.
[42] Reimers, C.D., et al. (2012). "Age-related muscle atrophy." Current Opinion in Clinical Nutrition & Metabolic Care, 15(3), 241-247.
[43] Kemmler, W., et al. (2010). "Exerc training affects bone." International Journal of Sports Medicine, 31(7), 508-513.
[44] Bird, S.R., & Hawley, J.A. (2017). "Update on insulin sensitivity effects." Sports Medicine, 47(8), 1541-1549.
[45] Tiainen, K., et al. (2013). "Physical activity and aging." Journal of Applied Physiology, 114(7), 961-967.
[46] Leproult, R., & Van Cauter, E. (2010). "Sleep and hormonal changes." Current Opinion in Endocrinology, Diabetes & Obesity, 17(1), 43-49.
[47] Van Cauter, E., et al. (2008). "Impact of sleep and sleep loss on neuroendocrine and metabolic function." Hormone Research, 67(Suppl. 1), 2-9.
[48] Oyetakin-White, P., et al. (2015). "Does poor sleep quality affect skin ageing?" Clinical and Experimental Dermatology, 40(1), 17-22.
[49] Irwin, M.R., et al. (2016). "Sleep and inflammation." Sleep Medicine Reviews, 25, 52-64.
[50] Jackowska, M., et al. (2012). "Short sleep duration is associated with shorter telomere length." PLoS One, 7(10), e47292.
[51] Sundelin, T., et al. (2013). "Cues of fatigue." Sleep, 36(9), 1355-1360.
Join Us on Your Aesthetic Journey
Every PM Aesthetics consultation begins with lifestyle assessment, not treatment sales. We evaluate sun protection, nutrition, sleep, stress, exercise, and other factors that determine 70-80% of aging outcomes. If your lifestyle foundation needs attention, we'll tell you, even if it means less treatment revenue for us. Medicine first, always.