Forgoing the Facelift

What if you aren't comfortable taking the big step? Cosmetic surgeons offer advice about preventative procedures and alternative options, no matter your age.

Even in a world where cosmetic surgery is growing more routine, some people still pause at the idea of getting a facelift. Many times would-be candidates remember the days before the operation became a maintenance procedure scheduled earlier in life — a time when a woman of a certain age went away for a “vacation” and came back looking so much younger. For others, it’s a sure admission that they’re as old as their driver’s licenses say they are. And for people who simply aren’t yet comfortable taking that step, cosmetic surgeons say there are preventative measures and temporary fixes for every decade of life that’ll allow you to put your best face forward.

Teens & 20s

Preserving a fresh face begins early in life with the development of sterling health habits. Pepper Pike plastic surgeon Dr. Lu-Jean Feng stresses acne prevention or control through proper skin care, including medical treatment if necessary, and a diet heavy on fresh fruits and vegetables.

“If you have very bad cystic acne, you may end up with acne scars that actually look like wrinkles when you get old,” she warns. Even worse on the skin are smoking and excessive exposure to sunlight, including the rays emitted by tanning booths and beds.

East Side plastic surgeon Dr. Gregory Fedele notes that the former constricts blood vessels and, in turn, decreases blood flow to the skin. The latter decreases elasticity and increases fine lines, wrinkles and pigmentation. It is also a major contributor to the development of skin cancers.
“The majority of lifetime exposure to sun is in the first 20 years of life,” Fedele notes. “That means before the age of 20, you already have 75 [percent] to 80 percent of your lifetime exposure to sun.”

Fedele says adequate sun protection begins by applying a sunblock containing at least SPF 15, which is included in many moisturizers and cosmetics, before heading out for a day at school or the office. On days spent outdoors, both the SPF and frequency of application should increase. (Fedele estimates an SPF 40 sunblock will screen approximately 97 percent of harmful ultraviolet rays.) He recommends reapplying it at least every two hours.

“Throw away your suntan lotion from last year and get a fresh bottle,” he urges. “A bottle of suntan lotion should not last all summer if you’re going to be in the sun a lot. It should only last a couple of weeks.” He also advises wearing a visor or brimmed hat and sunglasses that shield the entire eye area.

“The more you squint, the more you’re using the muscles around your eyes, the more lines you’re going to see,” he says.
The 30s

During this decade, skin-care regimens need to be re-evaluated. Some people, for example, find the soaps that helped clear breakouts during their teens and twenties are too drying. Feng introduces Retin-A, a topical prescription medication that increases cell turnover and collagen production, to improve patients’ skin texture and reduce the appearance of fine lines.

Fedele says another option for stepping up exfoliation and promoting collagen development is a regular scheduling of light chemical peels. “What you can do at home will only take you so far,” he says of the various scrubs and over-the-counter treatments.

But perhaps the most-requested service during this decade is injections of Botox, a refined protein produced by bacteria that can be used to smooth lines caused by muscle action between the brows, on the forehead and radiating from the outer corners of the eyes.

“It stops the muscles from moving, thereby stopping the wrinkles from forming,” Fedele says.
The 40s

By the time many people hit the big

4-0, they’re looking to soften deeper lines that are developing — the most common are the folds extending from the corners of the nose to the corners of the mouth — with another class of injectables, “fillers” such as Restylane, Juvederm Ultra and collagen. (For more on these injectables, see page 108.) Feng says she also uses them to fill “marionette lines” at the corners of the mouth, pre-jowl indentations, depressions that form under the eyes and fine lines, as well as fill out the lips.

By the late 40s, however, Botox injections alone may no longer be enough to mitigate aging in the upper third of the face. Fedele says more of his patients are scheduling an upper and/or lower eyelid lift, technically known as a blepharoplasty, to remove excess skin and fat around the eyes, and a brow lift to reposition sagging eyebrows.

“For most women, the eyebrow should be a little bit above the bony rim of the eye,” he says. “Most men have the eyebrow right at that bony rim.” Both surgeries are performed on an outpatient basis and require seven to 10 days for the bruising and swelling to subside.
The 50s

At the half-century mark, a lifting of the jaw and neck areas may be required. To achieve it without a full facelift, Feng suggests trying Thermage. The treatment involves exposure to a controlled amount of radiofrequency energy that heats the collagen in the deeper layers of the skin and underlying tissues, causing them to contract. The tissues are in turn stimulated to produce new collagen, creating further tightening. Although the treatment is administered under mild sedation in the office with no downtime, there are drawbacks, mainly variability in results and pain.

“Some people respond better than others,” Feng says, “and some people can’t tolerate the discomfort.” Resurfacing the skin with a Fraxel laser, a gentler version of the carbon-dioxide laser that resurfaces the skin without denuding it of its top layers, provides a similar tightening but no lift.

Shortening a lengthening nose can trim up to five years off the face, according to Dr. Bahman Guyuron, chairman of plastic surgery at University Hospitals of Cleveland and a professor at Case Western Reserve University. “There are ligaments that attach the tip of the nose to the rest of the structure,” he explains. “As we get older, those ligaments loosen and allow the tip to migrate toward the lips.” Removing a wedge of tissue from the tip and reattaching it with sutures — a procedure done through the nostrils — restores (or creates) the attractive upturned nose so many people desire.

Similarly, Guyuron improves the appearance of aging ears by reducing earlobes lengthened by gravity or years of wearing heavy earrings.   
Fedele notes that many patients in their 50s ask about quickie facelifts such as the “thread lift,” in which sutures are placed in the deep tissues of the mid-face through incisions in front of the ear, then suspended from the temple. Like most board-certified plastic surgeons, he does not recommend or perform them. Candidates for the procedure are limited to those with a minimum of hanging skin on the face and neck. The sutures can actually pull through the tissues, negating any improvement. And even if the sutures hold, the results last only six to 18 months.  

“It’s a very attractive procedure for patients because the recovery time is less than that for a facelift,” Fedele acknowledges. “But the results are also less than those for a facelift.”

There does come a time, of course, when temporary fixes are no longer sufficient to maintain a youthful visage. According to Feng, it is when people “max out” on skin-care services, injectables and minor nips and tucks that they often decide to opt for a facelift. Fedele says the results are generally better when it’s performed at a younger age, because the skin is more resilient and the improvement less obvious.

“But it’s a very personal decision,” he stresses. “No one needs a facelift.”
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