Facelift &Treatment of Aging: My Philosophy
"Traditional" techniques for the treatment of aging include facelift & eyelid surgery. These techniques were developed during the 1920’s and '30’s. Today, there are new ways to treat the symptoms of aging.
My approach is based on the analysis of my patients, of available new technologies & techniques, and feedback from my patients.
Elements of Aging
Aging has two elements: genetic & environmental.
Genetics should be fairly obvious. You will probably age like your parents and grandparents did. If they are "well preserved," you will likely be "preserved," too. If you family ages poorly, unfortunately, you will too.
Environmental factors are sun, tobacco, alcohol, and the pollution of living in an industrial society. Sun and tobacco often have the greatest impact on your appearance.
Sun damage accumulates from the day you are born to the day you die. While you can’t change past sun exposure, you can reduce future sun damage with sun screen and/or sun protective clothing.
Assessing Your Appearance
The "cornerstone" of your appearance is your eyes. The more youthful your eyes appear, the more youthful you will appear.
You wish to frame your eyes, with your cheekbone below and you brows above. Your eyes create a figure-of-eight lying on it's side.
Your mid-face extends from your brow to the base of your nose. Ideally, your eyes should be 50% (or less) of your mid-face.
As you age, you lose cheek volume, your face "lengthens."
"Bags" under your eyes usually represents normal fat, not excess fat. Removing this fat around your eyes may make your eyelid smooth, but it is my experience your appearance does not improve as expected. Traditional lower eyelid surgery may also change the shape of your eyes. With the advent of laser resurfacing, I have not found the need for traditional lower eyelid surgery.
Improving Skin Texture
Skin Care
As you age, the dead skin cell layer of your skin becomes thicker and disorganized (similar to dryer lint after towels). Improving you skin thru skin care takes time. Your skin cells are replaced about every 6 weeks. Up to 6 skin cycles, or 36 weeks, may be needed to see maximum effect of treatment.
The most basic treatment is exfoliation, or reducing your layer of dead skin cells. Exfoliation is a three step process: two at night, and the third in the morning. The first step is to clean your skin with a special cleanser. In addition to removing dirt, grime, or make-up, cleansing prepares your skin for the second step, your exfoliant cream. The cream works over night, softening and loosening your dead skin cells. The third step (in the morning) repeats the cleansing process, removing the loosened dead skin cells.
Altered skin pigment is usually the result of a combination of sun damage and hormone changes in your system. Pigment care requires a combination of reducing pigment cell activity with removal of pigment causing ultraviolet light (like sunlight). Sun damage is both visible and invisible. Fading agents, such a hydroquinone, are combined with tretinoin (generic for Retin-A), kinetin (Kinerase), and sun protection.
Skin Resurfacing
Texture is improved by directly treating your skin with over the counter medications (like Kinerase), prescription medications (like Retin A or Renova), chemical peel, and/or laser resurfacing. Laser resurfacing now includes flash resurfacing, the newest, least invasive aggressive resurfacing technique.
"Flash" resurfacing is a very new resurfacing technique. The "flash" technique requires no anesthetic, and takes only 15-20 minutes per treatment. A course of four treatments spaced 1-2 weeks apart is recommended. Your skin texture will continue to improve for up to 1 year after your last treatment.
CO2 Laser resurfacing offers the most dramatic skin changes, but it is the most invasive treatment for improving your skin.
Retin A & Renova help to reverse sun effects on the skin. It causes changes in the deeper layers of the skin. In addition to reducing fine lines, it may reduce brown spots in treated skin. Skin irritation is common, particularly early in treatment. These agents require a prescription.
Kinerase is an over-the-counter product. It can give all the benefit of Retin A or Renova without the irritation or sun sensitivity. Used twice a day, Kinerase requires 2-4 months to achieve maximum effect. Due to the lack of side effects, I prefer Kinerase for most of my patients.
Options for restoring lost volume include fat injections, dermal grafts, mid-face lifting, or using "off the shelf" fill material, such a Gore-Tex or Alloderm.
Whenever possible, my preference is to use your own tissue (fat injection or dermal grafting). Both choices offer permanent changes in your appearance. The degree of permanence will vary from patient to patient.
Fat injection is best for larger areas of restoration (such as your cheeks). Dermal grafts are best for localized areas, such as your lipstick line, or the frown lines between your eyes.
Natural (but dead) fillers, like collagen, are more likely to be absorbed by your body over time. Cosmoplast is a human-derived collagen. ALthough it is more expensive than cow-collagen, the risk of allergy is low enough that skin testing is not required before treatment.
Artificial filler, like Gore Tex, is permanent, but reactive tissue that forms around the implant may cause an unnatural feeling around the implant.
Newer fill materials are under evaluation. Radiance contains the same form of calcium that is found in sea coral. With the consistency of school paste, it must be injected below you skin, not into your skin. About 1 in 10 patients will have "lumpiness" at the injection areas. This usually responds to massage, but may require 10-12 weeks to improve. Radiance is thought to last 2-3 years, an possibly longer. Radiance is not yet FDA approved for cosmetic applications.
Mid-face lifting repositions displaced soft tissue from your cheek. Using incisions inside your lip and in your hairline, mid-face uses permanent "inside" stitches to lift your cheek.
Removal of skin excess may be combined with volume correction, or after your facial proportions have been restored, and your skin texture improved. Like a rubber band, over time, attempts to elevate your cheeks by face-lifting will see a loss of elasticity and recurrent droop. Repeated lift surgery can lead to the unattractive "pulled" appearance.
If you have a dramatic excess of skin under your chin, there are treatment alternatives that don't require the extensive surgery of traditional facelift surgery. Such treatments require very individualized assessment of your aesthetic requirements.