Facial rejuvenation is one the most commonly sought after goals, but often, one of the least understood by patients. Clearly the source of most patients’ knowledge is the Internet, but more often than not, it only muddies the waters when it comes understanding the various options available today. It seems like there is yet another new and improved way to halt the aging process touted every day, and it can be a challenge for even the well informed, to sort out what truly works and what is just hype.
The aging process involves all the structures of the face over time and starts from the day we are born. The area that is most visible and evident, and justly receives the most attention, is the skin. The skin of the face is tightly tethered to the underlying muscles, which allows us to emote by creating various facial expressions. The gradual development of facial wrinkles is the result of years of accumulated damage due to these muscles as well as sun damage, smoking, poor nutrition, disease, and a host of other factors that are too vague to be defined. So what to do? Well, the first step is prevention, prevention, prevention! As a child, I used to believe my naturally tan skin protected me from sun damage. Years later, I have come to learn that while this may confer some degree of protection from some types of skin cancers, it by no means is a magic shield that protects me from aging. Termed Photoaging, the end result of years of exposure to UV light from the sun is this:
• Reduced skin strength and elasticity • Thinner, more translucent skin • Fine and deep wrinkles • Dry and coarse skin • Superficial fine, red veins on the ears, cheeks, and nose
Bottom line? Protect your skin from the sun by using sunscreen and wearing protective clothing, don’t smoke, eat well, and drink plenty of water.
Beyond prevention, a well planned skin care regimen based on your skin type and condition can help reduce the appearance of fine wrinkles and sun damaged skin. There are some substances available that do work, if only slightly, such as retinol and alpha-hydroxy acids, however the vast majority do not. Be forewarned: non-prescription cosmetic products are not required to be tested for effectiveness by the FDA. Spending a lot of money on expensive creams and lotions is probably the wrong way to go.
Here is what does work and why: • Botox • Dermal Fillers (such as fat transfer, restylane, juvederm, collagen, etc.) • Skin resurfacing • Surgery
1) Botox
The one most popular and effective non-surgical therapy is Botox. This is a natural protein that works by blocking the chemical signals that cause muscles to contract. Repeated folding of the skin and subsequently development of deep creases in the skin are one of the tell-tale signs of aging. Early on, the muscle activity in the face produces skin folding that disappears when the muscles relax. As time progresses, this skin folding gradually progresses from fine lines to deep creases, specifically in the forehead, between the eyebrows , the crow’s feet, and the laugh lines. The way Botox helps is by weakening the muscles that contribute to these deep creases, and thereby softening and flattening them.
Getting Botox is a pretty simple process, and it can be done right in the doctor’s office. The doctor will use a fine needle to inject minute amounts of Botox into the muscles to be treated. By varying the amount of Botox and the muscles treated, doctors can reliably treat the desired areas and preserve your natural facial expressions. The good news and bad news is that Botox only lasts a few months. So, if you’re a newbie and just want to try it, you can rest assured that it won’t last forever. For those of you who love it, the good news is that you will need less Botox, less frequently, if you maintain your treatment, because the muscles will get smaller with time.
2) Dermal Fillers
Let’s say you have deep creases between your eyebrows (glabella) and you weaken the muscles with Botox. Well, if you’re lucky enough not to have formed permanent wrinkles, then that should be enough. But for many people, this is not the case. When the damage has already been done, all Botox can do if prevent the lines from deepening even more, but it can’t erase the deeply etched grooves that are already there. The answer here is to fill in that deep grove with one of many options – known as dermal fillers.
Generally speaking, there are two categories of dermal fillers – semi-permanent and non-permanent. For brevity’s sake, I will only discuss the most popular type, the non-permanent fillers. The few that make my short list are:
• Fat transfer • Restylane (non-animal source) • Captique (non-animal source) • Hylaform (animal source) • Cosmoderm/Cosmoplast (non-animal source collagen) • Sculptra (non-animal source) • Juvederm (non-animal source) will be available soon in U.S.)
Clearly, there are many different types of fillers available, and they all vary in terms of longevity of effect, ease of use, and predictability of result. The most popular fillers now are fat transfer and Restylane.
Fat transfer is more invasive than all of the others listed, however, it is the only one that uses your own tissue. The process involves removing small amounts of fat from the stomach, hips, or thighs through a tiny incision (like liposuction) and then injecting that same fat into the desired area. The main thing to know is that anywhere from 30-80% of the injected fat will get absorbed by the body and will need re-treatment. The good news is that usually after two to three treatments, most patients will have a permanent result.
Restylane is a non-animal based product that comes packaged in a syringe. It is composed of hyaluronic acid (HA), which is a substance that occurs naturally throughout the entire body. It is safe, non-allergenic, and non-toxic. It is also non-permanent – most of it gets absorbed within 6 months to 1 year. However, it is particularly good at filling in small lines and wrinkles, particularly around the laugh lines and between the eyebrows, for lip augmentation, and pretty much anywhere else you want to use it. Some patients prefer it over fat because it is simpler to do, gives a predictable immediate result, and there is minimal down time after injection.
The others listed all have their own disadvantages; Captique and Hylaform are similar to Restylane but doesn’t last as long; Cosmoderm/Cosmoplast are collagen products, that also don’t last as long as Restylane; Juvederm was recently introduced to the United States, but there isn’t enough collective experience to comment on it yet. The only one that deserves more attention is Sculptra. It is the only one that is capable of helping the body form new tissue around it, thereby increasing it’s duration of effect.
3) Skin Resurfacing
This is a technique that basically rejuvenates the skin by removing the topmost layer skin. It can work for very fine wrinkles, sun-damaged skin, uneven skin tones, and acne-scarred skin to create a smoother, tighter, more uniform appearance. There are many different ways to do it, and the most popular ones are listed:
• Chemical peels • Laser resurfacing • Dermabrasion • Microdermabrasion
They all work in their own way, and different doctors will prefer one over another. Chemical peels can vary from light to deep peels, and involve applying a solution to the skin. Laser resurfacing works by doing the same thing as a peel, except it uses a high-intensity light to destroy the outer layer of skin. Some advocates of the laser method also say it helps to tighten the skin by stimulating growth of new collagen fibers, but this is a debatable claim. Dermabrasion and microdermabrasion are similar in that they both mechanically “sand” away the top layer of skin, however, microdermabrasion has a quicker recover period because it doesn’t go as deep as dermabrasion.
The bottom line for skin resurfacing is this: they all have recovery periods that last weeks, they all can result in slight red to pink appearing skin for several months, and they all can result in “hyperpigmentation” – a darkening of the skin – in darker skinned individuals. Skin resurfacing is recommended for people who are well informed and understand this because it certainly does work, but they have to be willing to accept a prolonged recover period of one to two weeks and “skin redness” for several months.
4) Surgery
Some of the non-surgical therapies discussed above do work, but they can only do so much. The most dramatic and striking rejuvenation can only be achieved when you combine them with surgical therapy. As I mentioned previously, the effects of aging lie in a spectrum, depending on where you lie on that spectrum, different options become available to you. Here are some of the most commonly performed operations for the aging face:
• Brow Lift (forehead lift) • Cosmetic Eyelid Surgery (Blepharoplasty) • Face Lift, Mid-Face Lift • Cheek Implants • Cosmetic Nose Surgery (Rhinoplasty) • Lip Augmentation • Neck Lift
The procedures listed directly correlate to the relentless effects of aging • low hanging eyebrows • tired, puffy looking eyes with heavy upper eyelids • sagging face with wrinkles, deep laugh lines, and jowls • hollowed out areas under the eyes • droopy noses • thinned out lips • sagging skin in the neck with a pouch of fat tucked under the chin.
It is very important to note that these surgical procedures are not recommended for everyone, but depending on what areas you are most interested in treating and which things bother you the most, an individual treatment plan should be developed by you and your doctor.
Dr. Nirav Savalia is a Santa Monica plastic and reconstructive surgeon who has chosen to specialize in aesthetic surgery, encompassing cosmetic surgery of the face, breast and body. Recognizing that beauty is truly in the eye of the beholder, Dr. Savalia provides a warm and attentive bedside manner that will allow you to express your desires and goals in a relaxed and unhurried manner. A comprehensive consultation will include discussing all surgical and non-surgical options to formulate a truly individualized treatment plan. Dr. Savalia is dedicated to achieving the most beautiful and natural results by combining technical excellence, artistic skill, and meticulous attention to detail that is based on years of advanced surgical training. To learn more about Dr. Savalia, please visit his website at: http://www.drsavalia.com | |
