Before The Facelift: How a Multi-Faceted Program of Non-Surgical Treatments Can Postpone The Facelift
Most people focus on the facelift when they think of plastic surgery, and rightly so as it is still the main reset for facial aging. Still, there are several decades of facial aging before a facelift is indicated. During this time, a plan of treatment is needed to correct the earlier aging changes taking place, as well as to maintain appearance and prevent or slow the onset of facial aging. In fact, non-surgical treatments of the face have become by far the predominate treatments being provided these days.
There are non-surgical modalities that are used in concert to create the desired anti-aging and rejuvenation appearance goals. Medicated skin products, laser and energy based treatments and injectables like neuromodulators (Botox, Dysport, Xeomin and Jeuveau) and fillers (e.g. Restylane, Juvederm and a growing list of others) are mixed and matched based on what features are aging and the preferences and lifestyle limitations of the individual to prevent and restore early facial aging. Given all the options and the range of aging changes encountered in people aged 30, 40 and beyond, Dr. Bass explains how a plan should be constructed in partnership with an experienced plastic surgeon who has a full range of options, surgical and non-surgical, available to patients.
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Doreen Wu (00:00):
Welcome back to Park Avenue Plastic Surgery Class. My name is Doreen Wu and I co-host this podcast where we explore controversies and breaking issues in plastic surgery. I’m excited to be here with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The title of today’s episode is “before the facelift: how a multifaceted program of nonsurgical treatments can postpone the facelift for a decade as someone who is young enough to be in the pre facelift group.” I’m excited to hear about the ways that a facelift can be postponed with all of these cutting edge nonsurgical aesthetic treatments.
Dr. Lawrence Bass (00:40):
Exactly. Doreen. This is really a critical part of plastic surgery. It’s great to fix an aging change in someone’s face, but the ideal is to help people just stay the same and keep looking young, modern plastic surgery actually spends much more time on prevention, support and maintenance than on restoration. In this episode, we’ll discuss how a variety of treatments, support appearance without downtime and have modulated the average age for the facelift
Doreen Wu (01:15):
In years past, it seems like facial rejuvenation options were largely limited to a facelift, but now we have so much more at a disposal. Can you describe some of the components of nonsurgical, facial maintenance and rejuvenation?
Dr. Lawrence Bass (01:30):
Sure. Uh, this relies heavily on treating changes in the skin, as well as treating laxity and volume loss in the face. So skin surface changes are things like redness, either broken blood vessels or little red dots, or just a general red or plethora look often that’s rosacea brown changes. Our pigmentation gets less even as we age. Uh, but we also sometimes get brown spots that people call sun spots or age spots or liver spots. Uh, those are really from sun and wrinkles loss of the smoothness of the skin and the turker of the skin. And this is really all about chemical peels, laser peels, and all of the no recovery lasers and energy devices that have evolved out of the laser peels. That’s one big category. It changes then there’s skin laxity, um, very early in the game. And this means in your late thirties in your forties, various energy options can give you a little drop of skin, tighten up, not so much to take away a big, a big degree of skin laxity, but to keep the amount of skin laxity at a minimum. Um, there are also some minimally invasive options where energy is introduced through needle punctures in the skin. These procedures have a little bit of recovery time or where there’s sutures suspension under the skin, again, a little bit of recovery time, but local anesthesia and no need for the anesthesiologist.
Doreen Wu (03:23):
And what about, I think most people consider Botox and fillers, a little bit of the bread and butter of plastic surgery. What do those types of, um, treatments do?
Dr. Lawrence Bass (03:34):
Yeah, they’ve really become the mainstay of what happens in medical treatments to prevent and reverse aging changes. So volume loss in the face, which starts in our twenties starts to become evident as contour, depressions and emptiness in our late thirties and forties and fillers, or if we’re in the operating room, fat grafting can restore some of that shape, fill in those hollow or sunken contours. These are things like the nasal labial fold, the marionette lines, loss of volume and curviness in the lips, flattening of the cheeks, hollowing of the temples and hollowing of the tear trough the transition zone between the eyelid skin and the cheek skin in the lower eyelid, Botox and other neuromodulators. The official name for these medicines is neuromodulators, Botox, Dysport, Xeomin, and Jeuveau. I like the word relaxers. These are for dynamic wrinkles. So wrinkles that are not fixed into the fabric of the skin, but are there because of resting muscle tension, bending our now somewhat less elastic skin. And so most of the upper facial lines, the frown lines between the eyebrows, which are sometimes called the elevens bunny lines on the side of the nose, when you smile or laugh far headlines, crows feet that are not fixed but happen when you smile or animate, these are all routinely and best treated with neuromodulators or relaxer medicines. Other changes in lip wrinkles, marionette line, neck banding are also well treated with the neuromodulators.
Doreen Wu (05:37):
It makes sense that patients are finding that they can delay surgery for a few years or even extend the results from an older facelift by utilizing all of those maintenance and rejuvenation treatments that you just described. I didn’t realize there’s so many different options available, which makes me wonder what I should be doing.
Dr. Lawrence Bass (05:57):
And this is what everybody wants to know, what, what should they do? But there’s no single answer. It’s a product of your skin type, where you are in aging changes, what features you’re seeing and how much those features happen to bother you. You know, one person will look at crows feet and be very upset that they’re there. And other folks say, I don’t mind those so much. I earned them, but I hate some other feature. They hate the deepening of marionette lines or they hate hanging skin or gel. So what you need to do depends on what you’re seeing and what bothers you. And it, it also really revolves around how much work you want to do in maintenance. There are people who spend two hours a day playing with their skin with skin products, medicated skin, lotions, and so forth. And other folks, you know, want a quick medicated moisturizer. They can put on in the morning and a different product for nighttime. That’s not going to invest more than 10 or 15 minutes a day. So everybody does what suits them.
Doreen Wu (07:10):
Let’s say that I’m a new Yorker who has a busy schedule and is starting to see some fine lines and wrinkles that weren’t there a few years ago. I like looking like me and I don’t really wanna change my looks or my age, if I don’t have to, what can I do? What are some of my options?
Dr. Lawrence Bass (07:28):
So for starters, home skin care products, and there are thousands of products, some of them have really useful medications in them and enough of the medication in there to have an effective dose. Um, others do not, but there’s no single answer for that because everyone’s skin is different. So the skin is like a puzzle and you have to tinker with skin medicines to figure out if they’re doing something meaningful for you, but on the early end of aging, certainly things like that, microdermabrasion, which is an exfoliation of the skin that’s done mechanically, but is very gentle to the skin is a good option. And some of the light or epidermal chemical peels that that are no recovery peels that keep the skin bright, fresh, even. I think microdermabrasion like the dental cleaning of the skin, whatever your skin is doing, it’s probably going to benefit you and your skin will be healthier.
Dr. Lawrence Bass (08:31):
It, it picks up the things you’re not getting with your home skincare process. Just like you brush your teeth at home, you get most of what’s there, but you get your dental cleaning once or twice a year to really deep clean the things that you’re not successfully removing on your own. So that’s the start. Um, eventually you’re really gonna have to coordinate with a skillful provider and I believe a collaborative back and forth works incredibly much better than just doing something single treatment by single treatment with someone who’s really providing a technical function and not a consultative function with you. Um, so someone who has a lot of options who understands the whole range of aging changes, Botox and fillers, as you said, are really the mainstay once you’re actually seeing established aging changes. Uh, and there’s a whole level of activity. That’s now picking up momentum where in addition to energy treatments to stimulate collagen in the skin or skin medicines, medicated skin products to stimulate collagen, we also put energy or dilute filler under the skin to further stimulate from below. In addition to from above,
Doreen Wu (10:02):
There’s a really fine line between what is too much and what is too little. I have friends who are approaching their mid twenties and are considering whether to start getting preventative Botox. At the same time. I also see influencers on social media post about going in for maintenance, Botox and filler a few times a year, and possibly even getting some laser treatments and chemical peels on top of that to really keep their skin in optimal shape.
Dr. Lawrence Bass (10:30):
So there’s definitely a trend towards this. What’s been term rejuvenation. You don’t look older yet, but you never want to get to that point. And I think it really is a, a gen X kind of, of behavior or a millennial kind of behavior. Those patients come in and say, I never want to look older. You are gonna keep me from looking older. We’re gonna start working on that now. And obviously you can overdo that, but it’s not a bad idea to think about problems before they develop and take limited steps to maintain and prevent and neuromodulators Botox like medicines are a perfect example of that. The thought is if you keep the muscles relaxed in places, we know, tend to wrinkle as we age, instead of ironing in a line for the next 20 years. And now it becomes visible all day. Every day, we prevent that by putting small amounts of Botox, there is also a trend towards, you know, micro Botox. Uhlin toxin medicines, neuromodulators have multiple effects on the skin besides just relaxing muscle. It controls sebum production and other things in the skin. So we’re just starting to understand that there may be a much broader role for these medicines, separate from what the label indications are. So this is off-label use, but it’s being studied and examined more and more as we realize there’s so much more there than we appreciated at the beginning.
Doreen Wu (12:18):
I’ve also heard of Botox being used to control sweat production and reduce the amount of sweat when it’s injected and to say your underarms, or maybe even your hands.
Dr. Lawrence Bass (12:29):
Yes. The use for hyperhydrosis or just to reduce sweating. That’s an on-label use of Botox, um, and has been known for many years, the effects on other things, the skin does oil production and other things is very analogous to the effect on sweating but has not been as completely exploited. And we’re just starting to learn more about it.
Doreen Wu (12:58):
I wanna go back to the generational divide that you pointed out. It reminds me of an article I read recently that was talking about how plastic surgeons are seeing a huge uptake in the number of millennial aged patients that are coming into their offices. And interestingly enough, the article mentioned how in the past patients would bring in a picture of a celebrity or a model from a magazine and say to their plastic surgeon, this is who I want to look like. Whereas nowadays, millennials being the tech savvy consumers, that they are, will show their plastic surgeon a filtered, or touched up photo of themselves and say, I want to look like this.
Dr. Lawrence Bass (13:41):
Yeah, I’ve seen that in my practice as well. I, I think there were iconic images of beauty in the past that various forms of media had promoted or that were trendy at the time. And I think the view of beauty currently is much broader and more diverse. People want to look like themselves rather than, uh, on balance or most of the time there are individual exceptions rather than emulating a celebrity appearance or a trendy appearance. Um, it’s not entirely true. There are trends in, in appearance that people are pursuing in terms of body, shape, lips, other things, but, uh, but more and more people want to be their optimized self or their beautiful self rather than somebody else,
Doreen Wu (14:33):
Um, to kind of steer us back on track. Can you describe some of the common problems that you see in your patients when it comes to rejuvenation and maintenance treatments?
Dr. Lawrence Bass (14:45):
So again, it goes back to those basic problems we, we talked about, the skin surface changes, dynamic wrinkling, skin quality and laxity. Um, and that’s what we’re trying to address. Um, a younger patient might mostly be working with medicated skin products at home and only doing a couple of in-office treatments a year just to boost the, the effectiveness, uh, if they’re not seeing quite as much as they hope from the home skin products, once there are some established aging changes, it really becomes a wrinkling contour, depression, correction, along with skin brightness, skin evenness. So there’s some energy treatments a couple of times a year for that, or light chemical peels along with some, some, uh, neuromodulators like Botox, Dysport, Xeomin, Jeuveau, and, uh, and fillers, um, as laxity becomes a little more of the focus energy treatments above and below the skin and diluted, uh, stimulatory fillers below the skin, uh, has a role early, early in the laxity process.
Dr. Lawrence Bass (16:05):
So those are examples of, of what different patients are focusing on, mostly working at home with an occasional boost in the office, a schedule of typical fill and neuromodulator muscle relaxation versus a more intensive program of really trying to stave off the need for surgical intervention, separate from that, you know, patients, hunger for perfecting or maximizing their beauty outcomes varies all over the map. As I mentioned earlier, some people come in and just a particular aging change, bugs them. And some of the other changes don’t really show up on their radar. Um, they come in and say, I really hate my lipstick bleed lines, and I don’t care too much about the other stuff. Other patients come in and say, just fix everything. You know, I’m getting older, whatever you see, take aim and fire. Um, and, and there’s another group of patients that say, look, life is good.
Dr. Lawrence Bass (17:13):
I see these things. I wish they weren’t there, but I’m too busy doing things that are important to me. So that’s an okay answer as well. But basically if you see something that bothers you and we have a reliable way to improve it, then that’s the thing you should pursue. If I see something, but you don’t care about it, or you see something and I don’t have a good way to fix it, then we probably should leave well enough alone. It’s not important that I see something it’s only important if it bothers you, uh, when something bothers you enough, that it’s worth undergoing the inconveniences of whatever treatment is involved, that’s when it’s time to schedule it. You know, we all see a dozen things. If we had the magic wand, we’d change our appearance, but since we can only do it the real world way, it has to bug you enough to be worth what, whatever the treatment is going to involve.
Doreen Wu (18:10):
If only there was this magic cure solution, I think a lot of people would be much happier. Um, but many would still prefer to avoid surgery. If nonsurgical alternatives might provide comparable results or at least a noticeable improvement for someone who wishes to maintain a youthful natural appearance and would like to stave off various signs of aging, what should they take away from this episode? Dr. Bass,
Dr. Lawrence Bass (18:39):
The takeaways are, are pretty simple and common sense. Um, it’s really worthwhile to have a plan of preventative and maintenance care that will always help you look your best versus just, you know, sitting back and waiting till you need to take some big step. Um, when you’re 20, I like to say you’re wash and wear. You don’t need very much to look your best, but as we get older, we need a little more maintenance. And that goes, a little maintenance goes a long way. The beauty of this is you’re in the driver’s seat. You can do a lot or a little at home or in the office, depending on what suits you. And if you’re happy with your appearance, you’ve done enough. We have seen a transition to looking better for longer because of nonsurgical treatments. It’s very clear from the data that nonsurgical treatments are raising the average age of facelift over the past two decades.
Dr. Lawrence Bass (19:41):
And lifestyle changes have helped with that as well, less sun, less smoking and so forth. Um, people age in certain typical patterns. And that lets us predict what likely will be useful, but everyone is aging as an individual. So it’s really looking at what you have a level of concern about rather than copying what your friends are doing. And I call this beauty thermostat and beauty lens. So, you know, a thermostat could click back on if the temperature drops by a degree or it could wait till it drops three degrees before it clicks on. It just depends how sensitive you are to small changes in appearance. And then the beauty lens is, you know, what, in your eyes is important to your appearance. And again, doesn’t matter what your friends are doing or a celebrity is doing. It’s, what’s important to you. Any care plan should be customized and not cookie cutter. That way you can partner with an experienced provider and find a plan that fits your needs and budget.
Doreen Wu (20:47):
That was a really interesting metaphor. And I, I think that’s an important distinction that you just made between that beauty thermostat and beauty lens. Well, thank you for joining us today, Dr. Bass, this was an eye-opening episode, and I know I learned a lot about the different non-surgical treatments and technologies that can be used to target aging and delay the need for surgery. This is Doreen Wu, thanking you for joining Dr. Bass and me for this discussion of treatment programs for facial aging, designed to postpone the facelift. What non-surgical treatments would you like to hear more about email us to let us know, and we will discuss it in a future episode as always be sure to join us next time for our episode on after the facelift prevention, maintenance and restoration. Continue,
Speaker 3 (21:36):
Thank you for joining us in this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor-patient relationship is established by listening to or participating in this podcast, consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.