What Is the Skincare Routine of a Plastic Surgeon?

Patients ask me this more than almost any other question that isn't about surgery. And I understand why — there's something compelling about what the person who knows the most about skin actually does with their own. So let me be direct and specific. This is what I do. Not what I recommend to every patient across the board, not a sponsored list, not a marketing piece. Just what I've arrived at after years of reading the evidence and experimenting on myself.

I'm not naming products. That's intentional. Products change formulations, brands come and go, and what matters is the ingredient and its mechanism — not the label on the tube. If you understand what you're looking for, you can find it in any price range. The evidence doesn't care about the brand.

1. Exfoliation — Two to Three Times a Week

I use a chemical exfoliant rather than a physical scrub. The evidence for this distinction is clear: physical exfoliants (anything abrasive) create micro-tears in the skin surface over time, disrupting the barrier and causing more inflammation than benefit. Alpha-hydroxy acids (AHAs) — particularly glycolic acid and lactic acid — work by dissolving the intercellular cement that binds dead keratinocytes together, allowing them to shed naturally and revealing the newer cell layer beneath.

The clinical evidence supports AHAs for collagen stimulation in addition to simple exfoliation. Glycolic acid at concentrations of 10–20% consistently shows dermal remodelling effects in published studies, not just surface-level benefits. I use a leave-on AHA formulation at night — not a rinse-off product, because leave-on concentration and contact time matter for effect.

The reason I don't do this every night is simple: skin tolerance and barrier integrity. Daily AHA application, even at moderate concentrations, can compromise the epidermal barrier over time. Two to three times per week delivers the regenerative benefit without that cost.

2. Vitamin C — Every Morning

Topical vitamin C, specifically L-ascorbic acid, is one of the most well-evidenced topical antioxidants in dermatology. The mechanism is dual: it directly neutralizes reactive oxygen species (free radicals) generated by UV exposure, and it functions as an essential cofactor in collagen synthesis — stabilizing the hydroxylation of proline and lysine residues in the collagen triple helix.

I apply it every morning, before sunscreen. The reason for morning specifically is that its primary function is photoprotective — it scavenges the UV-generated free radicals that cause DNA damage and accelerate collagen degradation. Applying it at night, when you're not being UV-exposed, misses its most important utility.

A few practical notes: the stability of L-ascorbic acid is one of its weaknesses. It oxidizes on exposure to air and light, changing from clear or pale yellow to orange-brown as it degrades. Oxidized vitamin C loses efficacy and may introduce its own oxidative stress. I use formulations that are packaged to minimize air exposure and replace them on a schedule rather than waiting until they look "bad enough."

Effective concentrations in the evidence base range from 10–20%. Higher concentrations create more irritation without proportional additional benefit. I use 15%.

3. Retinol — Every Night That I Don't Exfoliate

If vitamin C is well-evidenced, retinol is the gold standard of anti-aging topicals, full stop. The literature on retinoids for skin aging is among the most robust in all of dermatology — decades of randomized trials, histological data, and clinical outcomes consistently confirm effects that no other topical class can match: increased epidermal thickness, stimulation of new collagen synthesis, accelerated keratinocyte turnover, reduction of photodamage pigmentation, and smoothing of fine lines.

The mechanism is relevant: retinol (and its more potent cousin, prescription retinoic acid / tretinoin) binds to nuclear retinoic acid receptors, which directly regulate gene transcription. This is not a surface-level effect. It changes how skin cells behave at a genetic level, which is why the results are real, measurable, and histologically confirmed.

The reason I say "every night I don't exfoliate" is that combining active AHA and retinol in the same night creates more barrier perturbation than benefit, especially at first. I alternate: exfoliant nights and retinol nights, with a plain moisturizer-only night worked in when skin needs a break.

On starting retinol: I advise patients what I follow myself — start low frequency and low concentration, then build. Retinoid dermatitis (dryness, peeling, redness in the first few weeks) is largely avoidable with a slow introduction. It is the most common reason people abandon retinol, and it's almost entirely unnecessary. The "skin purging" phase is real but time-limited. The long-term data are compelling. Start low. Go slow. Stay consistent.

4. Moisturizer — Layered with Humectants, Emollients, and Occlusives

A properly functioning skin barrier is not vanity. It is physiology. The stratum corneum — the outermost layer of the epidermis — maintains the water gradient between skin and environment, prevents transepidermal water loss (TEWL), and acts as the first line of defence against environmental irritants and pathogens. When the barrier is compromised (by over-exfoliation, harsh cleansers, environmental stress, or simply aging), every other product you apply becomes more irritating and less effective.

My approach to moisturizer is layered: I use something with both humectant and emollient properties. Humectants (hyaluronic acid, glycerin) draw water into the skin from the environment and deeper layers. Emollients (fatty acids, squalane, ceramides) fill in the gaps between keratinocytes, smoothing and strengthening the barrier. I look specifically for ceramide-containing formulations because ceramides are the dominant lipid in a healthy stratum corneum — the data on topical ceramide supplementation for barrier restoration is solid.

The order matters in my routine: actives (vitamin C in AM, retinol in PM) go on first, to a clean and relatively dry face. Moisturizer goes over top to seal and protect the barrier post-active application. An occlusive (a thin layer of something like petrolatum or a rich balm) goes over that on nights when skin needs extra recovery support — particularly after a retinol session.

5. Sunscreen — SPF 50+, Broad Spectrum, Every Single Morning

This one is non-negotiable and it is the single highest-leverage intervention in skin longevity. I say this as someone who operates on photoaged faces every week: UV damage is the primary driver of visible skin aging. Not chronological aging — UV damage. The evidence separating intrinsic aging from extrinsic (photoaging) is unambiguous. Cultures and populations with high sun exposure age visibly faster at the structural, histological, and clinical level. UV radiation degrades collagen, cross-links elastin, causes pigmentation irregularities, damages DNA, and drives the formation of reactive oxygen species that accelerate every dimension of skin aging.

Sunscreen is the most evidence-backed anti-aging intervention that exists. More evidence than retinol. More than vitamin C. More than any injectable, laser, or surgical procedure.

I use SPF 50+ broad spectrum (UVA + UVB coverage) every morning, last step before going outdoors, regardless of weather or cloud cover. UVA penetrates clouds and glass — it's responsible for the deeper collagen damage, and it's present on cloudy days and through car windows. The "I only go outside briefly" logic doesn't hold: cumulative incidental exposure is exactly how photoaging accumulates over decades.

Reapplication every two hours during significant sun exposure is what the evidence supports. I follow it. On surgical days when I'm not outside, once in the morning is sufficient.

6. Botox — Preventative, Regular, and Unapologetic

I get Botox. I say this openly because there is still an odd cultural resistance to the idea of a surgeon using non-surgical maintenance on themselves — as if doing so would somehow signal that surgery is less valuable. That is backwards reasoning.

Botox used preventatively does something surgery cannot replicate: it addresses dynamic wrinkle formation before it becomes static. Dynamic wrinkles (the ones that appear with expression — the crow's feet, the glabellar lines, the forehead creases) begin as expression-only lines. With repeated muscle contraction over years, the collagen fibres in the overlying dermis develop permanent creasing — the lines become static, present even at rest, and etched into the tissue. At that point, you are managing established damage rather than preventing it.

Preventative Botox (starting before lines are static) reduces the muscular forces that cause that progression. Given at appropriate conservative doses, it maintains natural expressiveness while interrupting the cumulative creasing process. The published evidence on preventative Botox shows measurable reduction in fine line formation compared to untreated controls over multi-year follow-up periods.

For me personally, it is maintenance — like how a surgeon's hands are their instrument. I am not trying to look frozen or expressionless. I am trying to look like a well-maintained version of myself, and to preserve that for as long as the biology allows.

The Honest Summary

This is what six key evidence-based steps look like in practice for me:

1. Exfoliation (AHA, 2–3x/week, evenings): Cellular turnover, mild collagen stimulation, pigmentation management
2. Vitamin C (L-ascorbic acid, 15%, every morning): UV free radical scavenging, collagen cofactor
3. Retinol (alternating evenings with exfoliant): Gold-standard collagen stimulation, epidermal renewal, photodamage reversal
4. Moisturizer (ceramide-containing, humectant + emollient): Barrier support, transepidermal water loss prevention
5. SPF 50+ broad spectrum (every morning, non-negotiable): Primary photoaging prevention — the highest-leverage intervention available
6. Botox (preventative, conservative dosing, regular maintenance): Dynamic wrinkle prevention before lines become static

None of this requires expensive products. All of it requires consistency. Skincare is not an event — it is a daily practice, the same way nutrition or exercise is. The compounding effect of doing the right things regularly is far more powerful than any one treatment or product.

If you're looking for a shortcut, I can't offer one. But if you're willing to be consistent with the evidence, your skin will reflect it in years — and the savings in future treatments will be significant.