[Editor's Note: A previous version of this article originally appeared in The Huffington Post]
This is the third and final installment discussing the aging patterns of our face. The first two blogs chronicled the process and factors affecting it. Recommendations were made to slow the aging process through lifestyle changes. For the sake of completeness, this last post offers advice on how to affect the aging process medically and/or surgically. These recommendations are purely elective, meaning they have no effect on your health, and are "cosmetic" alternatives. As outlined in Part 1, recommendations are listed by decade, as the goal is to offer procedures that mask the aging process subtly, without outlandish changes that scream "bad, fake appearance." Surgery or medical treatments are not for everyone, as individual aging philosophies differ significantly. The following guide is extremely general, and I do not propose that one do all recommendations offered per decade!
In most cases, wrinkles are just starting to become noticeable as skin changes have begun. A mild chemical peel or even a facial is an effective way to shed dry dead skin cells and help close pores and tighten skin. If lines around the eyes or forehead are noticeable when you are not animating (moving) your face, then Botulinum toxin (Botox or Dysport) offers a safe and handy way to erase those lines. I am not an advocate for use of Botox at a younger age to "prevent" wrinkles because research does not support this practice which would add up to costly treatments over time and create an unnatural frozen appearance to a young face. The practice of "maintenance" should be instituted as early as this decade to allow the appearance of slow subtle aging.
Wrinkles are deepening and regions like the mid brow show vertical furrows, sometimes called "11" lines, that can cause an angry appearing grimace. Crow's feet around the eyes and horizontal lines of the forehead deepen and can become harsh. Either or all of these areas can be effectively treated with Botox. Laser resurfacing or chemical peels are other options for fine lines and sun-damaged skin. Prominent smile lines around the mouth (nasolabial folds), can be blunted by filler products like Hyaluronic acid (Juvederm or Restylane). Some people may demonstrate redundant skin of the upper eyelids or bags of the lower eyelids, both creating a "sleepy" appearance. Surgical Blepharoplasty is the best option for either or both of these conditions. Various individuals may be candidates for "mini-facelift"' usually addressing a saggy neck or early jowl formation. The scars for this procedure are shorter, and recovery time less than a traditional facelift. Many times the neck and jowls can be tightened and contoured with just micro-liposuction.
As the aging journey continues, Botox and fillers offer a less invasive alternative to surgery. A new, denser type of Hyaluronic acid called Voluma, is very effective filling out deflated mid face and cheekbone regions. Fat transplanted from the abdomen or thighs is a potent alternative to treat hallowed regions of the face, and is natural. Cosmetic eyelid surgery is quite prevalent in this decade, and the perk is that it is usually a one-time affair and long lasting, unlike a facelift. Mini-Brow lift compliments upper eyelid surgery, lifting the lateral brow slightly. Mini-facelift is still a good option, especially when the amount of fillers increase to the point where the face takes on an unnatural bloated and absurd appearance (seen in many aging Hollywood types!). Fractional CO2 laser resurfacing is an efficacious treatment to reduce fine line wrinkling and modestly tighten the skin. The goal is to try to do smaller procedures with modest improvements, as opposed to drastic changes which can be alarming.
A traditional facelift and eyelid surgery (if not done earlier) with fat grafting offers the most practical alternative. Fillers are usually not as effective, and if they are serviceable, require so much material every 3 or 4 months, that a facelift actually makes more economic sense! Fillers and laser resurfacing are useful adjuncts to previous facelifts. Brow-lift surgery is helpful when the eyebrows drop, causing a tired or angry facial appearance. Earlobe reduction can be performed at the same time as a facelift, to rejuvenate earlobes that become enlarged by gravity over time.
70s and older
If healthy, you are not too old for a facelift, primary or secondary. Don't overdo it; don't ask your plastic surgeon to make you look 20 again! Aggressive facelifts look absurd, especially in older patients. A skillful facelift should make you look better, not necessarily younger. Most important, you should still look like you! Your plastic surgeon should require medical clearance by your personal physician. Lastly, if you choose a surgical option, no matter what decade, consult a board certified plastic surgeon.
I hope this review was helpful but remember, these are simply options. An alternative is to lead a healthy lifestyle, adopt a solid skin care routine, and simply grow older with dignity! I am a proponent of discovering and enjoying the inner and outer beauty in each decade of life. The choice is yours.
The secret of staying young is to live honestly, eat slowly, and lie about your age. - - - - Lucille Ball
Robert Tornambe, MD is a New York City Plastic Surgeon and Medical Advisor for Trueself. Certified by the American Board of Plastic Surgery, Dr. Tornambe has been practicing plastic surgery for more than 25 years. He is a fellow of the American College of Surgeons, was featured in NYMAG's "Best Doctors" issue, and was the Chief of Plastic Surgery at NYC's Cabrini Medical Center for 20 years.