Aging gracefully... an oxymoron or a mantra? This question is the crux of Plastic Surgery today. Years ago most people didn’t commit to surgical procedures until a large overhaul surgery in the last quarter of their lives, if at all. Today many more options exist then ever before, but before we can really have a discussion about how to tame Father Time’s effects we have to talk about what’s really going on during aging. Knowledge about these processes can be very powerful in diverting them.
Factors that contribute to our looks morphing over time can be broken down into internal and external. External causes focus mainly around sun exposure and its damaging effects on our skin quality and elasticity, habits such as smoking and alcohol intake, as well as high emotional stress levels all give the appearance of speeding up the clock and allowing our body’s façade to look older than our age. One only has to look at a group of elderly Buddhist monks to see how these factors excluded from life at an early age can result in baby faced adults. Internal factors concerning aging concentrate around hormone reductions, fat and muscle changes, loss of dental health, and bone/cartilage remodeling.
We, humans, blossom during puberty and maintain tight skin, strong muscles and hard bones during their 20s. Most aging seen in the face relates to the loss of facial volume and the corresponding support system which is designed to keep the soft fleshy parts of our face up against our facial bones. It’s a gradual process of weakening of these tissues which starts in our 30s and continues throughout our lives. Basically, as we enter middle age our environment’s influence begins to catch up with our internal factors and the appearance of age can seem to accelerate. This is when women begin to produce less estrogen, and men less testosterone. It’s apparent that elderly men and women begin to look more similar, than different, in old age. Interestingly this is not unlike how it can be difficult to distinguish the sex of new born babies and young children before secondary sex characteristics sprout.
Here’s a quick sketch of how age plays out on the face, area by area, top to bottom;
SKIN
In most cultures the skin of the face and hands is exposed on a daily basis to the sun’s harmful effects. This results in a roughened texture, increased wrinkles, loss of skin’s snappiness, and uneven pigment changes. These are the end results of all the cellular damage that ultraviolet light energy causes. Each of the remaining areas mentioned below have their appearance adversely affected by these changes due to the skin being the fabric which covers our face’s architecture.
FOREHEAD
Here’s where gravity comes in. From the moment we take our first steps Mother Earth is pulling us back home. This causes our forehead to lower, making our eyes seem smaller than in youth. The fat over our brow atrophies giving a bony look, and our forehead lines appear from the millions of times we flex the forehead muscles in expression.
EYELIDS
Eyelids have some of the thinnest skin on our bodies. No wonder they show the suns affects the most, resulting in that crinkly skin we all dislike. Lid support weakens and the protective fat that keeps our eyeballs cushioned begins to pop out just like little hernias, (lovely visual isn’t it?). Add to this that the muscle around the eye which causes blinking contracts 17,000 times a day or 6.25 million times a year and you can see why we all have crow’s feet, eventually.
CHEEKS and FOLDS
In youth our cheek fat is high up beneath our lower lid and thick. With time this fat diminishes and the little ligaments which hold it up stretch revealing a flattened area next to our nasal bridge beneath the lid. Now the bone is seen just beneath the skin and the whole area together gives the appearance of being tired.
The lines that connect our nose to the corners of our mouths are called the nasolabial folds. These folds of skin are fixed to the many expression muscles just below. This anatomic damn doesn’t allow our cheek fat to pass through it on it’s way back to earth, so the fat tries to overflow it which deepens the fold with age. The corners of our mouths begin to turn down as our cheeks descend and our lips thin from muscle and fat atrophy.
JOWLS
Jowls are really just our cheeks going south. This combined with a gradual weight gain over the course of your lifetime can make it hard to see the nice chiseled jawbone that you had in your high school yearbook.
NECK
Nothing drives patients crazier then an aged neck. This can be caused by one, or all, of the following. The same system of expression muscles in our face travel down the front of our necks. These are seen when you stick your neck out and forcefully turn the corners of your mouth down in the mirror. As we age these two muscles tend to separate right down the middle leading to each ones inner edge falling away from our neck. This looks like two strings under the skin, or neck bands. We also tend to accumulate excess fat in our necks, as well as loose skin.
Had enough? Well now you’re armed with knowledge and it’s time to fight back. This battle can be won on three fronts; lifestyle choices, non-invasive means, and surgical procedures. Where you choose to draw your line in the sand is a personal decision but here’s a starting point.
LIFESTYLE CHOICES
A.N.S.W.E.R. is the acronym that can help you to remember what the basics are when it comes to making good lifestyle choices towards aging gracefully.
ALCOHOL and smoking are two of the biggest external factors that can make us look old prematurely. Alcohol is a diuretic, which has a drying effect on us; this can cause your facial skin to be deflated, dry and flaky. Alcohol also depletes your body of vitamin A which gives you a sallow and unhealthy appearance. Smoking speeds up skin aging by producing free radicals which are highly unstable and powerful molecules that cause damage to your DNA. The cells of your body begin behaving erratically producing a range of cellular responses that make your skin age faster.
NUTRITION is the cornerstone of aging well. The typical American gains at least two pounds per year over his or her lifetime. That’s about 100 extra calories each day. Therefore if we burn off those 100 extra calories each day, or don’t ingest them to begin with we won’t gain that extra weight every year.
SUN avoidance is a no brainer. As mentioned above these rays wreak havoc on our skin cells. Therefore avoidance centers on trying to get the least amount of exposure as possible. It’s not enough to buy a fancy sunscreen; you have to use it on a daily basis. Your face and hands get sun everyday. Wear wide brimmed hats and avoid going out in mid-day sun if possible.
WATER makes up between 60 to 70 percent of our bodies. Most of us walk around chronically dehydrated. To figure out if you’re drinking enough aqua take your weight in pounds, divide this by two and that’s how many ounces you should be drinking in a day. If you’re out drinking alcohol you should drink an equal amount of water to combat its diuretic effect.
EXCERCISE is the key to keeping the weight off as we age. As most of us have the best intentions it can be difficult in our busy lives to dedicate an hour a day three to five times a week regularly. Instead try to incorporate exercise into the things you already do all day long. For example leave the house a little earlier and walk instead of taking the subway, the average person walks at about three miles per hour, that’s 60 North-South blocks here in the city. You do the math. Try extending and flexing your arms while pushing your child’s stroller to build strength, etc. Your body doesn’t know that you’re not in the gym. Try to turn the whole day into a kind of creative workout. It’s easier to exercise doing the things we have to do, then to feel as though we have to make time to go to the gym.
RELAXATION, ironically, can be one of the most difficult lifestyle choices to make. Many of us have so many of our personal and professional responsibilities swirling around inside our heads that we’re distracted from the world in front of our eyes. This mental chatter can make it very difficult to sleep at night as our brains try to make sense of it all. As little as five minutes a day of mindful breathing can begin to reset the circuitry in our brains, making some peace amongst all the chaos.
Well after making the right lifestyle choices you’ll be feeling better. You’ll also be looking better. These six areas incorporated into daily life may be enough for you to go about your days with renewed energy and increased confidence in your looks. If not, more options are out there.
NON-INVASIVE MEANS
More potions are now found in bottles and boxes in Plastic Surgery offices than ever before. This has been a major breakthrough since the old days of collagen injections. These products focus around weakening the facial expression muscles and thereby relaxing the face, plumping the soft tissues and folds, augmenting the facial skeleton, and resurfacing our skin as a fabric. We can now minimally, or drastically, enhance a person’s facial assets, or lessen their facial weaknesses.
The forehead, crow’s feet, and the number 11 between the eyebrows can all get ironed out with the two neurotoxins now on the market. The outside third of the brow can also be elevated slightly with these agents. It’s important to realize that these products don’t have to wipe your face clean of expression, which is a common misconception. They can be used with finesse to take the edge off of your resting expression. Movement can still remain, and that’s a good thing. These effects last between three to five months, then without another treatment your muscles will begin to strengthen again and the lines will return. They will not worsen if you do not continue with the products, you’ll just continue to age.
Plumping agents, or fillers as they’re commonly called, do just that. They take up space in the face. These products are analogous to stuffing a pillow with more feathers. Around the folds and mouth they are a camouflage technique to lessen the discrepancy between two neighboring areas of the face. If this kind of visual boundary can be minimized the human eye notices it less, and equates the anatomy to being more similar to how this area looked in youth. Other fillers work on a deeper level down near the facial skeleton. Augmentation here can offset some of the visible signs of the cheek fat decent, mentioned earlier. Again this is tricking the eye into seeing plumpness where it used to be back in college. These agents each last about one year.
One more product is used to stimulate your body’s own production of collagen by injecting tiny particles beneath the facial skin. This is a gradual process over a few months with two to three treatment sessions. The results give a smoother, plumper skin and lasts about two years.
All of these inventions can work wonders, but patients always ask why isn’t anything made permanent? I used to agree with them that it was a marketing ploy by the manufacturers to get people to keep buying products, and to some extent it is. But it’s more than that. Nothing in our face is permanent; our vision changes, our hair grays and our face drops. If these products were made to last forever they would begin to stand out over time, not blend in. Everything else in the face would be changing, and aging around them. They wouldn’t have the same relationships with the surrounding tissues as they did the day they were placed correctly. This is where more long-lasting surgical procedures come in.
SURGICAL PROCEDURES
Injectables have definitely helped ease patients into Plastic Surgery offices, so too have the advances in surgical procedures, themselves. Presently the rage in Plastic Surgery is to limit scarring and downtime. These may seem like obvious areas to focus on, but very often when these are addressed, results can diminish. More individuals are starting with smaller procedures at younger ages to avoid larger ones later in life.
The brow can be addressed either by endoscopic or minimally open brow techniques. These procedures reset the brow to its proper location before addressing the upper eyelids. Presently surgeons are very cautious to not over-do the amount of skin and fat removed from the upper lids. In the past this was overdone resulting in a skeletonized appearance. The youthful eye has fat around it, just not bulging.
The lower lids are also easily overdone producing a “fake” look. Here as well as the cheeks, laser resurfacing is very helpful in tightening some of the loose facial skin. This area of the cheek beneath the eyelid is called the midface and is surgically volumized by various ingenious lifting procedures, facial implants or with the patient’s own fat injections.
Nasolabial folds (or parentheses), jowls, and excess neck tissues are addressed during face lifting surgery. Here the underlying investing layer over the muscles is resuspended, trimmed, and tightened bringing much of the dropped fat back up onto the face into it’s youthful position. Then the excess skin can be removed leaving inconspicuous scars around the ears. All the expertise that Plastic Surgeons have goes into making these scars look like normal creases found along the ears in most adults.
For a complete description of these procedures please visit www.donaldrolandmd.com
As we go up the ladder from healthy lifestyle choices to non-invasive means and then to surgical procedures to obtain a more youthful appearance, it becomes paramount to always keep safety considerations in the forefront. These surgical options must be done in conjunction with the clearance of your general practitioner when relevant. Your overall health, the expected result, cost of the service and the recovery time must all be weighed into finding the solution that suits you best when trying to take back some control from Father Time.
Aging gracefully, an oxymoron or a mantra? You decide.
Donald Roland MD
Board Certified Plastic and Reconstructive Surgeon
RSS Subscribe
