With the explosion in non-surgical cosmetic procedures, particularly the injection of botox and skin plumpers, the focus on facial rejuvenation has, for many, shifted from the operating room to the office. While these injectibles modify the muscles and deeper soft tissues of the face they have little to no effect on the skins surface. Treatment of the outer covering was left to the patient, the cosmetics industry and the dermatologists. But with a younger population now seeking cosmetic improvement and fewer of these patients being surgical candidates, office treatments must include both subsurface enhancements and surface rejuvenation. Lasers have been in the limelight over the past several years for skin rejuvenation, but often have been limited in what skin types they could be used on or were simply less effective or more dangerous than advertised. With the cost of laser procedures often reaching into the thousands of dollars many aesthetic surgeons are still searching for a safe, cost effective, minimally invasive method of improving the skin. The important thing for the skin is not so much what method of treatment that you use, but doing it consistently. A logical approach includes a simple home treatment regimen of retinoids, skin lighteners and a new DNA repair enzyme cream. This is coupled with Hydrafacials and a variety of superficial to medium depth skin peels administered by a trained aesthetician. Medical grade skin peels have become much more sophisticated with the ability to target specific skin problems such as excess pigmentation, acne and photo aging with a variety of innovative strategies. Finally, non-invasive, non-laser skin tightening such as the Exilis treatment system offers skin rejuvenation without the down time, cost or risk of laser procedures. The money wasted on over the counter miracle creams would be better used on a simple, effective, medically guided skin care regime. Plastic surgeons will continue to improve structural defects and signs of aging, but they must become more aware of the importance of treating skin in the pursuit of beauty.