Saving Face

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The face of the 21st century is forever young. Plump lips, smooth foreheads, thin-lidded eyes and taut necks fill our magazines and television screens. Thanks to advancements in cosmetic aesthetics, a 60-year-old can now look 45 and a 35-year-old can shine like a 20-something. It’s a brave new world of fillers and lasers and mini-lifts, […]


The face of the 21st century is forever young. Plump lips, smooth foreheads, thin-lidded eyes and taut necks fill our magazines and television screens. Thanks to advancements in cosmetic aesthetics, a 60-year-old can now look 45 and a 35-year-old can shine like a 20-something. It’s a brave new world of fillers and lasers and mini-lifts, where youth can be bought for a few thousand bucks and hardly any pain or downtime, right?

Wrong.

It’s time to face the facts.

Most professionals readily agree that such non-invasive procedures as Botox, and skin filler injections such as Restylane, have pushed the envelope in the field of aesthetic medicine. But while they may provide a quick fix for some people—primarily those under 45—they’re not the answer for everyone, especially when used in isolation.

By the time we reach 50, most of us have lost skin elasticity in our face and in other areas. Non-invasive techniques won’t solve everything. What it takes is surgery. You know—a good old-fashioned facelift.

"Everyone loves the idea of a minimally invasive procedure," says Dr. David L. Mobley. He’s an American Board of Plastic Surgery-certified plastic surgeon specializing in aesthetic surgery of the face, breasts, and body. “But these aren’t always the right choices. In our 30s, we can use injectable fillers, lasers and other tools to correct lines and wrinkles. When we reach 40 and beyond, we may need to turn toward other techniques.”

It comes down to a simple fact, he explains. If you have a lot of skin laxity, you’ll need some type of lift to fix it. “It’s really the only procedure that can remove the sagging skin around the face and neck. A filler alone can’t solve this problem.”

But what about the promises of stitch-free miracle fixes?

“There’s a lot of hype being marketed to the layperson,” says Dr. Robert P. Hillstrom, a facial plastic surgeon certified by the American Board of Facial Plastic and Reconstructive Surgery. “Whether they’re selling the ‘Lifestyle’ or ‘Lunchtime Lift,’ or convincing people that noninvasive procedures will work on every face at every age, we need to educate ourselves about our options. No two faces are the same.

“The ‘Lifestyle Lift,’ for instance, is a variation on a conservative mid-facelift and is being sold as the miracle solution for every face, which is just wrong,” he continues. “In my practice, I offer two approaches to the aging face: the more conservative, mid-facelift, and the traditional full-facelift, the latter of which addresses the brow, neck and face. The mid-lift, as a rule, is more applicable to younger individuals, whereas this is often not enough to address the aging characteristics in the brow and neck that tend to be more noticeable as we get older.”

According Mobley and Hillstrom, here’s what you can expect to face in the mirror over the years.

Let’s skip the happy days of youth. By the time we hit our 30s, our eyes begin to show signs of aging, with crow’s feet and some eyelid bulging—nothing a little Botox and Restylane won’t erase. These are the years to take full advantage of injectable soft tissue fillers to soften wrinkles, folds and scars.

By our mid-40s, our cheeks begin to lose fat and laugh lines become sadly visible. As we push 50, creases open up on either side of our mouth, the jaw line slackens, and the muscles and skin of the neck begin to sag and lose definition. If we take it as a sign of character, great. If not, our best option is probably a combination of fillers, lasers, and a minimal lifting procedure—such as a mid-facelift.

By our mid-50s, gravity has taken its toll. Are you a sun worshipper? Fond of late-night partying? Look in the mirror and you’ll read the story of your life in the lines of your face. (And is it just your imagination, or are you starting to look more and more like Richard Nixon?) Don’t despair—repair is possible, though it’s going to take more work. Saving face, at this point, may involve a creative combination of a full facelift, brow lift, eyelid surgery, fillers and laser resurfacing.

Let’s start with the many varieties of the facelift.

The friendly facelift

“Today’s facelift is much better and safer than the one we did 10 years ago,” says Mobley. “Early facelifts tightened only the skin; now we’re able to remove excess skin and tighten lax facial muscles. We can also improve the skin quality with laser and other peeling techniques during the surgery.”

According to Mobley, the results leave you looking younger and more refreshed without a stretched appearance. Depending on your needs, the facelift can be combined with a forehead or brow lift, eyelid surgery (blepharoplasty), laser resurfacing, fillers and other procedures.

The full facelift (or rhytidectomy surgery) is the most complete and long-lasting procedure. The surgeon makes an incision starting at one ear, extending across the hairline, and ending at the other ear. After cutting away extra skin, tightening the muscles underneath and removing fat deposits, the doctor then reattaches the skin. This surgery addresses the entire face and neck, and results last from eight to 10 years. Cost ranges from $5,500 to $10,000.

The mini or mid-facelift is a partial procedure that affects only the cheek area. “You get what you pay for,” says Mobley. “It won’t give you the duration of a full facelift, and it doesn’t address the brow, eyes or neck, but it’s a reasonable procedure for younger people in their 40s who are just beginning to see some laxity in their cheeks. I might even use it on a 58-year-old who had a full facelift at 48 and just needs a little refreshing.” Both physicians stress that the mid-lift is not a replacement for the facelift. “It’s better to spend a little more and get the real thing, especially for people in their 50s and older,” says Hillstrom. Costs range from $3,000 to $6,000.

A brow lift fixes drooping brows and removes those frown lines in your forehead that make people ask what you’re angry about. In the conventional procedure, the incision is concealed beneath the hairline. The incision may be smaller (about a half-inch or so) if the physician employs a viewing device called an endoscope. “Endoscopic technique for forehead and brow is a novel approach that I use for some of my patients,” says Hillstrom. “The incisions are smaller. But the results aren’t always as noticeable or dramatic. I tend to not recommend that procedure unless the candidate just needs a little lift; it’s a tradeoff.” Costs range from $2,500 to $4,000.

Eyelid surgery (or blepharoplasty) removes excess fat, skin and muscle from the upper and lower eyelids. While this procedure can correct drooping upper lids and puffy bags below your eyes, it won’t correct crow’s feet, wrinkles or dark circles. Costs range from $2,400 to $5,000 per upper and lower.

Radiage and Sculptra

Dr. Michael Stampar is an osteopathic physician who specializes in aesthetic surgical and nonsurgical procedures. He’s excited about two procedures he feels are at the cutting-edge of aesthetic medicine. One is a nonsurgical skin tightening procedure called Radiage.

“It’s a remarkable improvement on Thermage,” he says, “which is a non-invasive radiofrequency technology that tightens skin and renews facial contours. The problem with Thermage is that the results aren’t predictable and the cost is often prohibitive. Radiage uses a more targeted radio frequency system to heat the soft tissue beneath the skin, causing the collagen to contract and tighten.” Stampar claims that the two-hour procedure can eliminate wrinkles and firm and tighten the skin of the forehead, face and neck. “It’s not the equivalent of a facelift,” he says. “It’s for younger patients who are just beginning to see signs of aging. It’s the only procedure I know of that turns back the clock on the skin itself. It’s reliable, there’s no downtime, and it’s not painful. Results last years—and you can look anywhere from five to 10 years younger.” Costs are about $2,000 for the full face.

Sculptra is another procedure that Stampar recommends. It was first used as a way to restore lost facial fat in people with human immunodeficiency virus (HIV). While it is not yet FDA-approved for other uses, Stampar feels it has great potential. “Sculptra stimulates growth of tissue,” says Stampar, “and is a great procedure for people who have loss of fat, resulting in hollow eyes and sunken cheeks. It’s like planting a seed under your skin; it’s true restoration—not a short-term cover.” He explains that Sculptra is injected beneath the skin, providing a gradual increase in skin thickness, especially in areas of creases, such as the fold between nose and mouth. It’s done in stages, he says, usually two to five treatments, administered four to eight weeks apart. The full treatment takes three to five months. “Sculptra works nicely for people in their early 40s and older, when they first begin to see changes in skin laxity or drooping skin. It softens edges, restores roundness and fullness of the face in an elegant manner.” Costs are $1,000 per treatment.

Fillers and laser treatments

· Laser resurfacing: One of the newest additions to facial cosmetic surgery, this treatment uses a concentrated beam of light to reduce wrinkles, sun damage, scars and acne. Local anesthesia or IV sedation is used and patients experience swelling, redness and irritation for several days. Although the desired effect may take months to achieve, one treatment is usually sufficient for long-term results.
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· Intense pulsed light: This laser technique can reduce and remove age spots, pigmentation, and redness caused by flushing or broken capillaries on the skin’s surface. Treatment is generally administered in four to six 20-minute sessions, four weeks apart, and results are long-term.
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· Fraxel laser: This treats aging, sun-damaged skin and wrinkles by triggering the body’s own natural production of new collagen and skin cells. Three to five treatments four weeks apart are necessary for long-term results. Mild discomfort and reddening and swelling can occur.
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· Botox: Smoothes and softens moderate to severe frown lines between the brows. One treatment lasts up to four months.
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· Restylane: A dermal filler made of hyaluronic acid that restores volume and fullness to the skin to correct facial wrinkles and folds, such as nasolabial folds. One treatment lasts approximately six months.
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· Microdermabrasion, or a “lunchtime peel,” is a skin-freshening technique that helps repair sun-damaged and aging skin by spraying tiny crystals across the face, mixing gentle abrasion with suction to remove the dead, outer layer of skin. A 30-minute treatment leaves skin fresh and rejuvenated for weeks.

What’s next on the horizon?

“What we really need is a procedure that can tighten skin without making an incision; that’s the next great frontier,” says Mobley. “We’re always on the lookout for the next true innovation. Unfortunately, we can expect a lot of premature hype and marketing until we get there.”

Where to start? Consult with a reputable physician or board-certified plastic surgeon who can give you a range of safe and effective options—custom-deigned for your face. Beware of anyone promising an instant and easy fix to all of your concerns.

“I’m comfortable being the last person on the block to try something new,” says Hillstrom. “It’s my policy to wait until a product or procedure has been universally determined to be safe before I will use it in my practice.”

Facial Figures
11.5 million surgical and non-surgical procedures performed in 2006
9.4 million non-surgical cosmetic procedures performed in 2006
3.2 million Botox treatments performed in 2006
$12.2 billion spent on all cosmetic procedures in 2006
7.6 billion spent on cosmetic surgical procedures in 2006
4.6 billion spent on cosmetic non-surgical procedures in 2006
Women accounted for 92 percent of all cosmetic procedures in 2006

SOURCE: American Society of Plastic Surgeons. Figures are for 2006.

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