Cosmetic & Reconstructive Plastic Surgery – Through the Ages!

By: Dr. Mitchell Kaye

Advanced Cosmetic Surgery Center of Kentucky

Today we will look at some of the most common issues facing women and men from say 30-60 years of age as well as their correction.

As we age, lines and wrinkles begin to appear as early as our twenties. Initially seen with movement of the forehead, corners of the eyes and mouth, these wrinkles will become etched into the skin as lines with time and repeated muscle contraction. Eventually the lines will extend and expand beyond their original boundaries, and will blend with skin folds that occur with advancing age in the 40’s and beyond due to loss of skin elasticity and fat beneath the skin. The picture becomes the recognizable face of age. Genetics and environmental exposure particularly to the sun may accelerate the process.

Proper skin care should begin in childhood with parents applying sunblock at least 1 hour before exposure. The same is true throughout adulthood. Use a sweat proof sun block is important when you will be outside and sweating. Don’t forget to reapply every few hours as directed and after swimming or sweating heavily. Men seem to do better with aerosol sunblock that takes only a few seconds to apply. This can be kept in the car or truck for immediate use. Apply the spray to your hands then rub your face, ears, neck. Other exposed areas can be sprayed for convenience. Women seem to be more amenable to spending time on their skin than men. The use of a skin care system that combines sun protection, brown (age) spot reduction and skin collagen rebuilding for smoother skin is ideal. The Obagi® skin care system does just that and can be used for long term benefit by women as well as men who want to take the time! It is a physician-directed system that is applied twice daily for long term use and can prevent or reverse sun damage and aging changes of the skin. Proper sun block also reduces the risk of skin cancer, a problem that we commonly treat as well.

The use of chemical or laser peels can be a powerful method of rejuvenating skin. The outer layer of skin can be removed in a precise manner by adjusting the peel or laser strength to allow fresh skin to re-grow on the surface. This new skin surface is smoother and less sun-damaged. It is important to note that deeper peels such as the Blue Peel or Laser Peels require weeks of proper skin preparation with Tretenoin and Hydroquinone (both found in the Obagi® system) to achieve a good result and are part of a physician-directed care plan for that patient. These peels are office procedures and have about a week or so of peeling afterwards as in the case of the Blue Peel. Results can be dramatic.

Once crow’s feet, forehead wrinkles or worry lines between the brows appear, the use of Botox® will provide about 4-6 months of improvement or elimination in some cases. Continued use can prevent deepening lines from developing over time. A good time to start is in the late 20’s or early 30’s for many people.

A subtle thinning of the eyelashes occurs with aging. Women will often notice this and use cosmetics to hide the issue. Latisse® is an FDA approved prescription medicine that is applied to the eyelashes themselves, much like mascara. Proper use of Latisse® actually makes eyelashes grow longer and thicker in almost everyone in a relatively short period of time and can really make the eyes stand out as a focus on a beautiful face.

By their 40’s, many people show deepening lines between the cheek and mouth (nasolabial lines), sagging of the middle third of the face as well as loss of lip volume (thinning or wrinkling of the lips) and other volume loss related facial contour changes. If you compare the smooth curve from the lower eyelid to the cheek of a young person to the multiple grooves, hills and valleys of the same areas in an older person you can get the idea of facial volume loss very graphically. Primarily this is a loss of fat in these areas. The use of fillers has dramatically changed the way people can look as they age. While we have not yet developed a process to prevent or reverse this fat loss, the use of fillers to restore this lost volume has given us the ability to hide the process. The use of fillers is a bit of an art and the Facial Plastic Surgeon can add volume to the face with several different FDA approved products, much as a sculptor can add clay to a facial bust. Hyaluronic acid (commercially known as Juvederm® or Voluma®) is a natural material found in our bodies in between cells. This gel is very well tolerated and provides a smooth and predictable volume replacement. The fillers are mixed with local anesthetic which makes the injection process generally well tolerated in the office.

Another option is to transfer fat from one part of the patients’ body, usually the belly or hip area, to the face. The advantage of a Fat Transfer is the large amounts of fat that can be transferred in one session with no cost of the material to the patient. After all, he or she already owns the fat! The fat is purified and injected into the deep face in the areas of deficiency. This procedure is done with sedation and local anesthesia in a procedure room as an outpatient and is a highly cost-effective method of facial volume enhancement. Fat Transfers are living tissue and the “take” or residual living fat cell volume can be unpredictable to some extent. This may necessitate a repeat procedure at a later date. A Fat Transfer is an excellent adjunct to face lifting, as we will discuss below.

Ultimately, when folds or hanging skin excess is present, a surgical procedure will be needed to remove the excess skin and tighten the structures beneath it. Currently there is no useful non-surgical technology, be it laser, radiofrequency or otherwise, that will make much of a difference in this situation. For example, a heavy, hanging neck will require a Necklift with removal of excess skin, as well as liposuction of excess fat and tightening of the loose muscles that are sagging beneath the skin as well. A Facelift will do the same for the mid and lower third of the face and is often combined with a Necklift and liposuction of the jowls. Sagging brows will require a Browlift to reposition the eyebrow in its proper position. Excess skin or fat of the upper or lower eyelid can be corrected with a Blepharoplasty. These procedures are best combined with volume replacement and proper skin care for maximal benefit. Of course, careful consideration and discussion with a Facial Plastic Surgeon is critical in defining the best course of action for the individual.