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Blepharoplasty Lady

PST 003: How to Take Control of Your Aging — Read the Transcript

February 27, 2018

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Welcome, Dr. Stephen Mulholland, plastic surgeon here in Toronto, Canada and this is part of our SpaMedica podcast series. I hope you’re enjoying them. We have another great one today.

A very common question women and men have when they are thinking about how to stop the aging process or minimize the aging process: “What actually happens to our skin and soft tissue that we look old?” I call it the 3 D’s of growing old. Our skin and soft tissue of the face and body undergoes deflation, loss of our fat contours and shapes. So pfft, like air out of a balloon. Once the balloon has lost its volume and support, it’s usually followed by a loss of skin elasticity, so we get deterioration in our skin, wrinkles, lines, then sunspots, broken capillaries, we get discoloured and wrinkled. And then without that support of the volume and the soft tissue, our skin sags or descends. So we fall, we deflate and our skin deteriorates. It gets thinner, it gets wrinkly, it’ll get discovered from sun damage and/or blood vessels, and that is the 3 D’s of growing old. As you’ll see later in our podcast series and seminar tonight, we’ll talk about how to battle the 3 D’S of skin aging.

So the common signs of aging then, the signs of aging are going to be visible loss of volume, so deflation, the hollowing under the eyes and the temple, around the mouth, not all at once, but usually from top to bottom. A skeletal look, a hollow look. The fullness of youth is there for a reason, a full face that doesn’t look too chubby is more youthful. Once you experience the loss of volume the next thing you’ll see are fine lines and wrinkles, particularly in the animated areas, upper lip lines, crow’s feet, frown lines, also called the number 11’s, and the horizontal forehead lines are worry lines, and with age and repeated animation we crinkle, crinkle, crinkle. Like an accordion we leave fissures behind. So visible animation lines that become lines even at rest.

If you get sun exposed or you’re driving, an ultraviolet light will lead to dark discolouration, so hyperpigmentation, and lastly, unwanted vessels and growth of spider veins and couperose or rosacea. Those are the signs of aging, discolouration, wrinkles, loss of volume and last but not least, loose skin, skin along the jaw line, extra skin under the eyes. These are the signs that you’ll see with the aging process. The same thing happens on the body just less visibly and often more easy to hide.

When do we start aging? It actually starts very, very subtly from about 28 to 30 on. We’re anabolic, we’re in the building phase of our life, building up collagen, building constructs of support and youth until about 28. At 28 the catabolic metabolism turns over and we start to break things down where our maximal strength and youth and vitality as athletes at 28, after that we lose muscle mass and strength and we’re breaking down, we’re not building up. You don’t really see a lot of visible signs of aging in your late 20s, even though it’s happening at a metabolic level. The earliest signs of aging are usually in the 30s, subtle lines from animation, maybe early loss of volume, or sun damage and sun exposure, or broken capillaries and redness.

So early signs of skin aging in the 30s, earlier for men and women usually because in our 40s women are going to be subject to fluctuation in hormones, loss of estrogen as they approach menopause, which has a visible and quite dramatic effect on the skin. Whereas men don’t have a true andropause like women do, our testosterone levels stay much more normal longer. Men typically get crinkly and wrinkly, but from a society perspective we don’t perceive men’s aging as much as women. Women will be noted to be aging from the signs of their skin wrinkling, deflating and descending. However, they might use some haircolour, some hair dye, keep their eyebrows tinted so they don’t show the signs of aging on the scalp, whereas men will age because we see gray, gray hair, gray beard, gray temples. So the hair will age and our skin will last longer and look more youthful relative to a woman of the same decade and age because of the estrogen effect.

Absolutely, the signs of aging can be greatly delayed, if not retarded, and in some cases even stopped. How so? Well, animation, over-movement leading to wrinkling early use of Botox Injectable in the early 30s. If you’re predisposed to a frown line, or a worry line, or crow’s feet like your mom might have had, you will stop those in their tracks and you will never develop them. So prophylactic baby Botox Injectable, small amounts of Botox Injectable to minimize the formation of lines before you get is a very common way that millennial’s nowadays will avoid growing old and looking old as they might have biologically. So absolutely, you can stop wrinkles in their track.

Sun avoidance, sunblocks and energy-based treatments like FotoFacial for brown and red discolouration can keep that at bay or eliminate it. And then volume replacement, either fat grafting or platelet rich plasma, or simple Juvederm to bring back the loss of volume that happens in the third and the fourth decade is, again, a prophylactic way to stop the aging process in its tracks.

Can you stop all aging? No, there will always be some signs of aging. Can retard and significantly reverse the signs of aging? Absolutely. Without any surgery, nowadays I tell most patients, you can look 10 to 15 years younger in your chronological age for the rest of your life without any scalpel by simple treatments with fillers, toxins, skin care, sun avoidance and energy-based devices.

I’m often asked, if I start making healthy decisions when I’m younger can I impact upon the aging process? The question is absolutely. There are things that we do called extrinsic aging, intrinsic is your genetic predisposition to getting old, you inherit that from your mom and your dad and there’s not much you can do about it, but environmental impact on your face and aging of the face, extrinsic factors … Sun exposure, try to minimize ultraviolet light exposure. Certainly, tanning and prolonged exposure is very unhealthy for your skin. You can get a number of sunburns and injuries in your 20s and 30s that will show up in your 40s as lines and wrinkles and sun damage. So ultraviolet light skin protection, very important. Always go with an SPF of 30 or more, try not to lie in the sun or tan, and that will minimize the aging of solar exposure, solar elastosis brings to your skin.

Smoking. Smoking is terribly bad for your skin. Smoking increases the lip animation, it stimulates mediators and toxins and oxidants that will break down collagen in your skin, so it’s very bad for skin health and internal health, heart and lungs, of course. So smoking, sun exposure, excessive weight loss, weight gain constantly stretching your skin and losing, stretching and losing will hasten the loss of volume and laxity, so weight maintenance. And then what you put into the diet to maintain that weight is important, beautiful skin from the inside out. Eat a lot of pro-oxidants, antioxidants, green leafy vegetables, antioxidant properties that you get some of the ginseng, ginco, glucosamine, some of those unnatural food products will really help with your aging. So beautiful skin from the inside out with a well-balanced diet. Minimize saturated fatty acids. A healthy diet equals healthy skin. No smoking, minimize weight loss and weight gain and of course, sun exposures. So there’s a lot you can do when you’re younger that will impact upon how and when you age.

What are the best options when you’re faced with early anti-aging treatments and then you’re already older and you’ve got established aging, what then? When you start in your 30s, the job becomes easier, Baby Botox Injectable, small amounts, forehead, eyes, minimize the wrinkles that are going to come.

Get on a healthy skin care regime, skin care regimes that help build collagen, even though you’re in the era when you’re breaking down collagen. Make sure you avoid the sun, make sure that if you’re losing volume you’re using nice sugar gels like Juvederm and Reston to bring back that volume subtly, but don’t use excessive amounts of it. And then the right energy-based devices, IPL, intense pulsed light, fractional laser to stimulate collagen. Nothing aggressive in your 30s and early 40s, simple energy, Botox Injectable and fillers with a good healthy skin care regime and sun protection. You can look perpetually 30 for a good decade and a half.

Now, once you’re older and you are aged already, you’re in your 40s or your 50s, you need to step it up a bit. There’s still going to be underlying Botox Injectable or Dysport, Xeomin, and you’re still going to use fillers where you’ve deflated and you’re still going to use lasers, but the kind of lasers you need are going to be much more aggressive, fractional lasers or radiofrequency devices that remove lines and wrinkles. More aggressive colour correction lasers like the pico second to take away resistant melasma or hyperpigmentation to even out colour. So energy based devices for smoothness and colour, Botox Injectable and Dysport and Xeomin for smoothing animated lines, adding volume to give you back the fullness of youth but not too much. And then when you start to descend too much, for those things to master it, suture suspension thread can get the jawline backup or mini-lifting. Selective small surgeries targeting fallen tissues to remove those fallen tissues, whereas the upper lid, the lower lid, the jawline and the neck are going to be something you consider in your late 40s and 50s.

So you can walk perpetually 49 for 20 years if you take the right approach to early aging, and then when Isaac Newton and gravity finally pull things down too much, use selective lifting and resuspension techniques to maintain a lifted but not pulled or done look. You can look natural and youthful for the entire rest of your life.

Are men perceived in our society as aging better than women? Usually that’s the myth, and the myth is wrapped up and enveloped in cultural perception and reality. What’s the cultural perception? Men generally age better than women is the popular myth, and that’s because we accept aging in men more than we do in women. So you can be a guy and you can be scraggly and wrinkly and gray and bald and portly, but often you’re judged by your success, with power and money. So you can look powerful, you can look like you’re wealthy and suddenly you haven’t aged as much.

The other reason is also biologic. We have a testosterone level that tends to last longer. It doesn’t fall precipitously so we don’t have a sudden andropause where all our testosterone goes out and we wither away with loose skin, muscle loss and fat loss. So we hang on to our musculoskeletal youth and our skin a little bit longer than women. We don’t have the same risk of weight loss, weight gain, from childbearing and we don’t have that sudden loss of estrogen with the estrogen effect and loss of that effect on our skin. So yeah, I think that men have a little underlying hormonal resistance to visible aging. We’re also culturally allowed to look a little older without considered being older than women do.

That is changing to some extent. A lot of younger men do in fact want a firmer jawline, they don’t want the double chin, they don’t want loose upper lid skin or bags, and they’re much more judged on their youth and vitality that, let’s say, the older mature people in our society, the grandfathers and the older men in their 60s and 70s would be judged far less harshly than younger men would be. So I’m seeing certainly in this new millennium, men are being judged much more equivalently to women on how the age, they’re taking better care of themselves, they’re more likely to do Botox Injectable and fillers and energy based skin care, they’re less likely to be smokers and less likely to have wide fluctuations in their weight. Generally, if you look young, you’re perceived as more knowledgeable, more successful, you’d likely advance further in your career and ought to be paid more. So young men get that just like young women do, so the young millennials I think will age … Whether you’re a man or a woman, there will be no gender discrimination.

In the older group of North Americans, men were allowed to age more dramatically and weren’t as judged as harshly as women were back in the ’70s, ’80s and ’90s, but that is changing. I think men and women are more apt to approach an anti-aging regime that helps maintain that youth and vitality because it will make a difference in how you’re perceived, which will often make a difference on how you’re treated in the workplace.

Is there an age past which cosmetic plastic surgery just shouldn’t be done? That’s kind of a relative question. I have many patients who continue tweaks and little injectable treatments, Botox Injectable, filler, energy-based treatments, well into their 80s and 90s. They maybe have done their lid blepharoplasty, their mini facelift, they’ve rearranged things that and they’re using nonsurgical treatments, injectables and lasers, to maintain and protect. That makes sense, but once your health has become a major issue, you have uncontrolled diabetes, uncontrolled hypertension, you have heart disease, you’re just biologically unwell, it is not safe to have cosmetic plastic surgery at that age without those kinds of medical conditions. So when your medical conditions become serious, cosmetic medicine just doesn’t make sense.

If you’ve waited too long and you are skeletal and cadaveric and in your 80s, it often doesn’t make sense to embark upon an aggressive course of cosmetic plastic surgery. When you’ve done a lot and you look great and you’re doing too much at a certain age, you start to outstrip a natural look for your age, then it’s often too much and often carried on too late in your life. So I think that you need a good plastic surgeon to know when to put the brakes on, you need to do plastic surgery when it makes sense medically, and I think you have to have a good balanced approach and allow yourself to age a little bit and also have those anti-aging tweaks to keep you looking natural and not done.

What are the ideal components of a skincare? Good skincare customizes the active ingredients, which are medical grade active ingredients, to the problems experienced by your unique skin. There’s different categories of problems in skin, there is the red, ruddy complected, oily skin, and they need a skincare regime that attacks the redness, the couperose or rosacea, the large pores and the oiliness, and the active ingredients needed must customize for that. There are groups of patients who tend to be more pigmented, that have hyperpigmentation, melasma, and both groups may need anti-aging. So you want active ingredients that build up collagen, make wrinkles smoother, undo any active inflammatory changes in the skin, redness and brown discolouration, melasma and rosacea, and then we want good toner, cleanser to desclamate the hyper-keratotic or thicker layers of our skin, and a moisturizer to keep the skin moist. All those need to be bundled under medical supervision if you want good active ingredients, and there’s a good 15 to 20 active ingredients that have been proven to work over and above what you can get over the counter at a Walgreens, or a Ralph’s, or a shoppers drug mart.

So you need medical supervision, plastic surgeon, dermatologist, facial plastic surgeon, a good skincare brand that needs to be under the prescriptive care of that physician, and a good analysis of your skin to begin that treatment program. And then you tweak the active ingredients over time, raise some, lower some, to get a customized approach to excellent skincare.

In my practice, I find I get that from Universkin, which is a bespoke customized physician-controlled skincare program that has turned out to be very successful for my very discerning and demanding patients.

So thank you very much again for watching and listening to our SpaMedica podcast series. If you’ve enjoyed the content that we’ve shared today, please share that on all your social media channels. We’ll see you next time.

Dr. Stephen Mulholland, MD
Posted by Dr. Stephen Mulholland, MD
has been practicing plastic surgery for over 20 years. He is one of Canada’s most renowned and best plastic surgeons in Toronto with his wealth of experience, artistry, and humbleness towards his patients.

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