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PST 008: Facial Rejuvenation — Read the Transcript
Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland, brought to you by SpaMedica. Today we have a very popular topic. Facial rejuvenation: how to look great, youthful, natural, fresh and rested. That’s what today’s podcast is on, the secret and science behind the modern techniques of looking awesome forever.
So, why is it that anti-aging and skin rejuvenation is the number one thing performed, because we grow old, and what is it that happens to us as we grow old? It’s called the 3-D’S of growing old: deflation, descent and deterioration. As we age, we get a hereditary lifestyle induced perimenopausal aging changes to the face characterized by air out of the balloon. The fullness of youth, our facial fat, melts away. We deflate in essence. It’s estimated that between 40 and 60 we lose a CC, or a tablespoon of fat every year, so by the time we’re 60 we’re about 15 to 20 CC of fat less, and we lose it under our eyes, temple area and mid-face, so we get gone to deflated.
Now, with the balloon not having air, the skin sags, so we get descent, deflation, then deterioration and we look droopy and saggy. From all of the animation around the eyes and the mouth, from sun damage, UV light exposure, rosacea, smoking, weight loss, weight gain, oily skin, we get deterioration, lines, wrinkles, folds, brown discolouration, red discolouration and macro pores. Those are the 3-D’S of growing old: deflation, descent and deterioration. And to look our best, we need to have 3-D therapy, a number of technologies and tactics to address each D. That’s the kind of comprehensive analysis and consultation you should expect from a modern medical spa, plastic surgery, noninvasive dermatologic center.
So in this rejuvenation driven technology sector, where do we as physicians, as plastic surgeons, offer the nonsurgical and the surgical? Do they fit together? Are they sequential? Does one delay the other? In reality, they’re quite complementary. Initially, you’re going to start with nonsurgical management, maybe in your 30s you’re going to use some sunblock, protect your skin from UV exposure, some baby Botox Injectable to minimize lines and wrinkles, some early soft tissue fillers in your lips where there’s early deflation. In your 40s you might start combining those anti-aging principles and tactics and strategies you used in your 30s, but you might add skin tightening and fractional lasers and energy-based devices for wrinkles and laxity and T-zone pores and colour correction with IPL FotoFacial for the brown or red discolouration. In your late 40s, you might combine surgery with that nonsurgical component, often in the eyes and upper and lower blepharoplasty. In your 50s, you still continue with your nonsurgical management and you might add a mid-facelift, and by the time you’re in your 60s, maybe a jaw and neck lift.
So one decade, and each decade you’re adding a room, the upper floor, the middle floor, the lower floor to your surgical repositioning, but you’re always, from your 30s on, engaging in 3-D therapy: deflation, descent, deterioration. Skin tightening technology, usually bulk heating RF, IPL photo rejuvenation for colour correction and fractional radiofrequency or infrared lasers for wrinkle reduction and tightening. Those things go on forever, and you mix your surgical procedures around that noninvasive envelope.
I commonly get asked, how much younger could I look Dr. Mulholland, and that really is a function of how old are you and what kind of 3-D aging tactics will work best for you. But in general, a 50, 55, 60, 65-year-old, 70-year-old patient can easily lose 10 to 15 years off their face with surgery and still look natural, look like themselves. A youthful, fresher version of themselves. With nonsurgical treatments, 45, 50, 55-year-olds can often look five to eight years younger with nonsurgical treatments, injectables, energy-based devices for colour correction, tightening and laxity. Those nonsurgical tactics can look surprisingly very youthful, not quite as good as we can with scalpel based surgery, but there’s less risk, less recovery than the more invasive procedures. But the only way to turn back the clock 15 or 20 years on a 70-year-old face is a good old-fashioned plastic surgery, lifting, tucking, removing and replacing.
Once you’ve done some of these treatments, let’s say the surgical restoration of your brow, your lids, your face, how long do these facial surgical procedures last? A blepharoplasty, your upper and lower lids, will last the rest of your life. A good brow repositioning and elevation, cheek or neck lift, will last a good 6 to 10 years depending on your lifestyle choices, smoking, weight loss, weight gain, sun exposure and the technique that the surgeon used. But I tell most facelift patients and brow lift patients that their rejuvenation will last 6 to 10 years. On average about eight years, you’ll think about doing it again. For the eye area, a good blepharoplasty is a once in a life treatment that lasts the rest of your life.
What’s the best time of year to do facial surgery? It really depends on your occupation and your willingness to stay out of the sun and cover. Typically, the winter months, January, February, March, April, are the best for facial surgery because it’s cold, it’s yicky out, no one wants to go outside, and you can hunker down, hideout and recover. However, many patients, professors, mothers of children that go off to camp in the summer, or students, will use the summer months to do their surgery recovery. So the seasonality of the best method to do a procedure has faded to some extent based upon your profession of when you get your time off.
For the nonsurgical procedures, in general, they are not permanent. Botox Injectable is, by definition, two to three times a year repetition. Volume shaping like with Juvederm, Voluma, Restalyne, or Belotero, that’s going to be once to twice a year. Anti-aging devices, the energy-based devices, FotoFacial, bulk heating radiofrequency like Forma, Venus Freeze, Exilis, Thermage, or Ulthera (ultrasound tightening) or fractional treatments. These treatments are temporary, you do a series of three, four, or five to get you looking five to eight years younger and then you need a maintenance once every four to six months. So two to three times a year to maintain your best results. The nonsurgical treatments with energy and laser-based devices are best done in the non-summer months because you’re not having any sun exposure, and sometimes after a laser treatment you can get some sensitivity to the sun. So your laser treatments are best done in the fall, winter and spring. Your surgical treatments are best done whenever you can have the recovery and, in general, pick a center that has a lot of expertise, a lot of excellence so you end up looking fresh, natural, rested and youthful, but still like you.
Are the rejuvenation needs and desires different for women and men of colour, of darker skin tone, Asian, Hispanic, middle eastern, Indian, Caribbean skin tones? The darker skin tones age differently than lighter skinned tones. Celtic, North, European, Anglo, Saxon, Germanic, Nordic, tend to age with a lot of wrinkles, red discolouration, deflation and descent. Women of colour tend to have thicker dermis, that’s the skin, the skin tends to be thicker than Caucasian, up to three times thicker. It doesn’t tend to wrinkle as much, it doesn’t tend to deflate as much, but tends to get more problems with dark discolouration. So brown discolouration on brown skin becomes one of the aging issues, under-eye discolouration. And then neck laxity continues to be very consistent among all skin types. So for women of colour, we’re looking for colour correction usually and then volume maintenance with tightening of the neck and jawline.
So again, thank you for joining me, Dr. Stephen Mulholland, here in Toronto, Plastic Surgery Talk. Our podcast today on rejuvenation, anti-aging, looking young, natural and fresh forever. If you really liked the content, please share it on all your social media channels, and we will see you back again for another podcast soon.
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