If You’re Not Quite Ready for Surgery, Consider This!
Were it not for the mirror, I probably wouldn’t believe it myself. I feel 25, but the mirror doesn’t lie and it reminds me, painfully, that I’m 41. It happened so gradually, it was like watching grass grow. Those little lines around my eyes that used to resemble tiny twigs have morphed into lengthy tree branches that have taken up permanent residence and found their way up into the edges of my hairline. Don't get me wrong, I would NEVER EVER trade what I have and the experiences that have led me to this milestone age. They are what have propelled me to this point, and although some experiences have been painful, I don't think you can truly live a life without those necessary bumps. Would I trade my skin and hair for that of my 25 year-old self? Of course! That's a no-brainer.
But since I have no fountain of youth at my disposal, I figure now is as good a time as any to explore what can be done in an effort to regain at least a little youth. Before I consider surgery, I’m dipping my pinky toe into the vast world of more subtle (e.g. nonsurgical) aesthetic tweaks. For that I turned to board-certified plastic surgeon, Dr. Laurie Casas, who shared a variety of ways one can rejuvenate their appearance without surgery and offered her perspective on when surgery is the optimal choice.
Melissa Chapman: What nonsurgical procedures are available to address the early stages of aging, and at what point do you recommend surgical procedures to your patients?
Dr. Casas: Skin protection, daily cleansing and moisturizing needs to begin from the get go, even before you see the first signs of aging, so if you haven’t already developed a regimen, do it now.. More specific medical skincare begins as a person starts showing signs of aging, typically in their 20s and 30s and most definitely by age 40.The medical skincare needs must be tailored to the individual by their doctor following an analysis of the patient’s skin quality, texture, tone and color. The patient should check in with their doctor regularly in the beginning, after their initial examination, and then every 4-6 months to be sure their skin is responding properly. There are factors that can change a person’s skincare requirements such as, weather because of the dryness or moisture in their climate and hormonal changes that occur monthly and throughout their life. I recommend patients check in with their doctors if they notice their skin is no longer responding to the prescribed regimen.
The goal is to maintain the skin tone, texture and quality of supple, moist, glowing skin throughout a patients aging process.
MC: How long does it last?
Dr. Casas: Forever, as long as the patient maintains and modifies their skin care plan over their lifetime.
MC: Under what conditions will it be difficult to give a satisfactory result requiring a definitive surgical procedure?
Dr. Casas: There is no surgical procedure to improve skin quality, however combination approaches using individualized skincare programs and light and energy-based technologies are used over a patient’s lifetime to address sun damage and visible signs of skin aging, which include fine wrinkles and thinning skin.
MC: What is the proper timing for a facial procedure and/or eye procedure? Is it better to wait and do the non-invasive and skincare procedures or is it better to go straight to the surgical procedures and have them done earlier?
Dr. Casas: I only recommend surgery when it is indicated. An example is an upper blepharoplasty when a patient has extra eyelid skin and bulging fat despite good eyebrow positioning. Oftentimes, neurotoxins like Botox, Dysport or Xeomin can be used to maintain a youthful brow position, thereby eliminating the extra lid skin. If the brows are in good position and the eyelid skin is puffy and sits on the eyelashes, surgery is the only option. However, doing the surgery early doesn't treat brow ptosis (low positioned brows) if that is the cause.
It is the same answer for a facelift. When a patient’s facial volume is restored, but they have excess skin or lax muscle, then a facelift is the ideal solution.
MC: If you wait to do a surgical procedure, will it be more difficult and yield a less effective long-term result?
Dr. Casas: Surgical procedures have specific indications. Whenever the patient shows these signs I would then recommend surgery. An example would be excess skin and lax muscle in front of the ear and along the neck despite adequate midface volume restoration.
Dr. Casas recommends these specific nonsurgical procedures to improve skin quality and improve aging skin:
Botox/Xeomin/Dysport: When a patient starts to see static wrinkles from using the muscles too much I would recommend this. The risks include injection discomfort, bruising and potential eyelid ptosis. The benefit to the patient is a decrease in wrinkles from muscle activity. It lasts on average 3-4 months and has been used since 2003 on millions of patients usually 3-4 times a year. Botox, Xeomin and Dysport are FDA approved and help smooth out the lines between the eyebrows. The only surgical alternative is excision of this muscle which has many risks.
Once it is no longer a viable solution, the next logical surgical procedure would be a forehead lift.
Hyaluronic acid (HA) and other injectable fillers: I recommended HA’s when a patient has a fold or wrinkle, or loss of volume in the cheeks and lips. The risks from these fillers include injection pain, bruising, and lumps and bumps. The benefits to a patient are a decrease in lines, folds and increase in volume that leaves a patient looking refreshed and supple. These fillers last on average about 4-12 months. The procedure can be done every 4-18 months since there is no evidence to show end point. When there is extensive skin and facial muscle laxity with loss of structural support, a definitive surgical procedure such as a facelift and/or neck lift is the next logical surgical procedure. Brand names of HA’s include Belotero, Restylane and Juvederm.
Retinoids: Research shows that when used properly it can help maintain the quality of the skin’s thickness. Risks include inflammation; however the benefit is that it lasts as long as the patient uses it. It can be applied several times a week to every day. It can also be used in combination with laser and IPL (intense pulsed light). As a physician, Dr. Casas prescribes Jan Marini Retin A every night and tretinoic Acid 0.05%, to be applied each night after mixing with a moisturizer.
Laser treatments, chemical peels and microdermabrasion peel away the top layer of skin damaged by sun exposure, lifestyle habits and aging process to reveal a radiant skin. These procedures stimulate the production of collagen restoring healthy skin.
Dr. Casas does not recommend surgical procedures to improve skin quality, but rather skincare products, injectables, lasers, chemical peels, IPL, and stimulators like Sculptra for maintenance.
If you are not yet ready to take the plastic surgery plunge, hopefully these nonsurgical aesthetic procedures will help you maintain not only your skin but your youthful spirit!