What’s in a face at 50, 60 or 70?

As time marches on, we see wrinkles, loss of facial fat, and sagging of the skin with deepening of the nasolabial folds (laugh lines), tired eyes, thinning lips and jowls.

As the New York Times points out, the loss of fat in the cheeks is part of a reshaping of the face over time. As soft tissue slides down over the cheekbone, producing laugh lines and making the cheekbones look a little flatter, the jaw line seems to widen because of the jowls.

Options

This is enough to make many consider rejuvenative facial surgery, or cosmetic surgery, but what are the options available?

As people grow older, the skin of the face begins to wrinkle and sag with the help of gravity and time. Exposure to the sun, genetic influences and other factors such as smoking also contribute to the effects of aging.

A facelift can correct these conditions and give people a more youthful appearance.

This procedure involves the tightening of facial and neck skin and muscles, as well as the removal of excess skin. Facelift incisions are placed in areas where they are minimally visible. The objective is to elevate the underlying structures and redrape the skin on the face in order to give a more youthful and rested appearance.

No single facelift technique is appropriate for all patients, and I use the approach that is best for each patient’s anatomy. In every patient I reposition the underlying foundation, which consists of fascia, called the SMAS, fat and muscle to restore tissues to their original position without stretching the overlying skin.

I trained with world-renowned surgeons in New York City who were among first surgeons to use the SMAS/platysma technique (the platysma muscle is along the lower cheek, jawline and neck). At the initial consultation I will tell you which of the procedures will give you the best and most natural result for your face and necklift.

Many people lose facial fat volume as part of the aging process, but people in their early 40s and 50s usually need volume redistribution rather than volume addition. When one has lost tissue volume in their face, I will add fat, which is taken from another part of the body.

What's in a facelift

A facelift incision begins in the temporal area above the ear, follows the contour of the cartilage of the ear, curves around the earlobe and continues up the back of the ear into the hair in a way that is not seen. I maintain the hairline in the front and back of the ear, and the temporal and sideburn area, in their original positions.

For some patients, a short scar facelift is possible in which the incision begins in the temporal area above the ear, follows the contour of the cartilage of the ear and then curves around the earlobe and stops. A short scar facelift works for an individual who does not have significant sagging of the neck.

Some current media articles and advertisements compare non-invasive and minimally invasive facelift procedures to surgical facial rejuvenation. It is important to take into account that the results obtained with non-invasive and minimally invasive procedures do not compare to the initial nor the long-term results that can be achieved with surgery. There definitely is a place for filler substances and Botox in the face, although these products cannot lift and restore sagging tissues.

Patients frequently ask "at what age should I have a facelift?" A patient, regardless of age, should not have a facelift until they have seen changes in the face that are a result of the aging process that they wish to have corrected.

The primary causes linked to the aging process are genetics, lifestyle - including factors such as sun damage — smoking , and weight gain or loss.

What about those tired eyes?

Blepharoplasty is a procedure to remove fat, along with excess skin, from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and the puffy bags under the eyes — features that make you look older and more weary than you feel.

The effect is to give the eyes a more rested, youthful look with a brighter appearance. Blepharoplasty can be performed on the upper lids, lower lids, or both and is often performed in conjunction with other facial procedures.

The forehead

A forehead lift or "browlift" is a procedure that restores a more youthful and refreshed look to the forehead, eye brows and upper eyelid areas.

By removing excess skin and muscle, the procedure corrects drooping brows, improves the horizontal lines and furrows that can make you look angry, sad or tired, and tightening the skin of the upper eyelid. The incisions are typically well hidden along the frontal hairline or in the hair, and with the use of an endoscope (a small camera that allows the procedure to be performed with minimal incisions), the incisions are more difficult to see. The particular type of incision to be used is dependent on your goals and specific anatomy.

Also, a forehead lift is often performed in conjunction with eyelid surgery (blepharoplasty) or a facelift to provide a smoother, overall balanced look to the eyes and face.

What if surgery is not needed yet or not an option?

Today, fillers and Botox can help rejuvenate without the downtime of cosmetic surgical procedures. Here are several popular ones:

Botox Cosmetic is a purified protein in an injectable liquid form. It is a non-surgical, physician administered treatment that can temporarily reduce moderate to severe frown lines between the brows in patients. During treatment, very low doses of Botox® Cosmetic are administered via a few tiny injections directly into the muscles that cause those stubborn lines between the brows.

Botox Cosmetic works by blocking nerve impulses, which reduces the movement of these muscles. With less movement, the skin surface gradually smooths out, and the moderate to severe frown lines between your brows begin to fade. Often the brow can be raised a small amount with Botox for those who do not need or desire a surgical browlift yet.

Soft tissue fillers like Juvederm and Restylane are viscoelastic gels made of hyaluronic acid that allow quick and noticeable corrections without the need of a skin test. They are injected just under the skin's surface at intervals along the wrinkle until the right amount is achieved.

Soft tissue fillers can be used to "fill" and smooth out deep facial furrows, acne scars, and smile lines. They can also be used to enhance the border of the lips for those who desire a fuller look. Treatments take less than half an hour, and may require a local anesthetic to numb the area.

Radiesse™ is a synthetic injectable filler that reduces wrinkles, creases and scars by augmenting the body's natural collagen supply. Composed of microspheres in a biocompatible gel, Radiesse is made from the same minerals found in our bones, so it carries little risk of allergic reaction. Radiesse can be used on many areas of the body, including the lips, nasolabial folds, peri-oral lines, depressed scars and oral commissures.

Injectable treatments typically take 15 or so minutes and require only local anesthetic. Side effects such as swelling or bruising are minimal and should fade within a few days. Results are visible immediately after the injection and can last for months or years, although the procedure can be repeated as often as you wish.

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To learn more about these or any of the other cosmetic procedures Dr. Jennifer Walden offers, don't hesitate to visit our place page or call our Austin plastic surgery office at (512) 328-4100 to schedule your complimentary consultation.