The 5 R’s of Skin Rehabilitation

When a patient consults with us regarding a concern with their appearance, we have found it invaluable to systematically evaluate them using a system we call “The 5 R’s of Skin Rehabilitation.” All of the treatments for cosmetic and aesthetic problems can be classified into one or more of the following five categories:

  1. Resurfacing

    Treatments that improve the appearance of the skin’s surface fall into this category.

    We begin life with a skin surface that has a uniform color and a smooth even surface. Various diseases, long term sun exposure, and the aging process can alter this ideal surface causing uneven color and texture. Brown spots, redness, scarring, and growths (keratosis are very common) are among the various abnormalities that resurfacing methods reduce or remove. Some of the many resurfacing methods used at the Orentreich Medical Group include [from mild to strong]:


    Chemical Peels

    Redness/capillary reduction

    Laser Resurfacing



    This category encompasses those treatments that relax particular muscles of facial expression. Early in life, the folds created when we squint, frown, or grimace quickly flatten and return to normal when we relax those muscles. Over time, as the skin loses elasticity, these facial expression lines become more permanent. A class of medicines known as neurotoxins is used to reduce the action of certain muscles of facial expression in order to produce a more youthful appearance. These include:






    This category includes all the methods of restoring tissue where it has been lost and adding fullness where it never existed, but could improve one’s appearance. The skin’s underlying support and shaping tissues can be lost as a consequence of aging, trauma, and certain diseases. The most common replacing treatments are injectable fillers. 

    Many types are available and your doctor will discuss the pros and cons of each so that a suitable choice will be made. The goal of replacing is to recreate, or at least approximate, the shape of a youthful face by filling indents and reducing unevenness. Fillers available at Orentreich Medical Group include:

    Belotero Balance®

    Juvéderm® Ultra XC

    Juvéderm® Ultra Plus XC

    Voluma® XC




    Sculptura® aesthetic


    Liquid Injectable Silicone


    Treatments that tailor the skin to better fit the supporting facial structure fall into this category. During our lives, the pull of gravity, combined with the shrinking (atrophy) of such supporting structures as bones, fat layer, and muscles can result in skin that appears loose, baggy or hanging. This is somewhat analogous to an article of clothing that has either stretched, or the person wearing it shrank; think of a dress that is too large for the person wearing it. Redraping methods resize and refit loose skin. At one time this category contained only surgical procedures [for example: face lifting, eyelid surgery, etc.]. Today it also includes non-invasive tightening procedures such as:  





    Into this category fall all of the prescription medicines and over-the-counter ingredients that can be formulated into skin care products and applied topically in order to improve the skin’s appearance, performance, and function. These include Retinoic Acid, salicylic acid, the alpha hydroxy acids, DHEA, 5-FU and retinol.

    Click here for more information on the in-house products we make for the exclusive use of Orentreich patients.