If you’re seeking a youthful glow and refreshed appearance, there are an array of rejuvenating options designed to take off years, restore elasticity and return the youthful glow that fades with time.
Many of those offerings are now minimally invasive and complement standard procedures such as face, neck and eyelid lifts or stand alone as fairly simple in-office treatments that deliver visible benefits.
Meanwhile, the menu of cosmetic procedures has expanded significantly to include effective skin care products, precise FDA-approved fillers, collagen-busting techniques and fat-erasing treatments. In addition, surgical advances are improving the recovery and outcomes of procedures such as breast augmentation, face-lift and nose reshaping.
These advances are making cosmetic enhancements more accessible to more Americans. Last year, cosmetic procedures increased 2 percent overall compared to 2014, according to the Plastic Surgery Statistics Report by the American Society of Plastic Surgeons.
Facial rejuvenation procedures experienced the most growth. Last year marked the highest number of botulinum toxin type A (Botox and related products) injections to date with more than 6.7 million procedures. Soft tissue fillers such as Juvederm and Restylane increased by 6 percent with 2.4 million procedures in 2015. And although breast augmentation dipped 2 percent last year, it remained the most popular cosmetic surgical procedure.
In fact, as cosmetic enhancements become more commonplace, some cosmetic surgeons suggest patients consider it earlier in life to more fully realize the benefits.
“I am convinced that when we delay aging, not only will a patient look younger, they don’t actually age as much as expected,” says Dr. Bahman Guyuron.
Protect the Skin You’re In
Taking care of your skin is truly the key to preventing environmental damage, such as sun exposure, and slowing down the signs of aging. Best practices should start in the teens and 20s, says Dr. Gregory Fedele of the Art of Plastic & Cosmetic Surgery in Beachwood.
“It’s never too early to start taking care of your skin,” he says. “There are basic things you can do that don’t cost anything.”
Wear sunblock and avoid tanning, because sun exposure translates to pigmentation issues, fine lines and wrinkling. “There is no such thing as a healthy tan,” Fedele emphasizes.
Don’t just rely on the sun protection factor included in makeup to protect skin from harmful UVA and UVB rays. Fedele recommends a minimum of SPF 50 when in direct sun, which provides UVA and UVB prevention in the mid-90 percent range.
Meanwhile, advances in skin care products have resulted in products that are truly effective at rejuvenating the skin.
“Getting started with a Retin-A type of exfoliation product, a moisturizer and good cleanser will keep your skin healthy,” Fedele says.
For years, skin care products were “mainly marketing and gimmicks,” says Guyuron. But that’s not the case today with some scientifically proven products available from professionals. For example, Retin-A, a brand name of tretinoin, is a prescription form of vitamin A that helps the skin renew itself.
“We know that skin care can unquestionably be improved with products,” Guyuron says. “With proper skin care we can delay changes in the skin to make it have that glow that is inherent to young skin.”
Without naming products, Guyuron calls out some key ingredients of today’s results-driven skin care products. “They are a combination of exfoliators and moisturizers,” he says. These products can also contain growth hormones and vitamin C.
Guyuron stresses that understanding how the skin ages can be helpful before using products or pursuing any cosmetic procedure.
“Facial aging has four components,” he says. The first is surface changes related to the environment: sun exposure, wind and lack of hydration.
Second is loss of volume. “We lose volume in the face in certain areas and gain volume in others,” Guyuron says. “We lose fat under the skin in areas such as above the eyelids, the lips, the creases between the cheek and lip.”
Third is droopiness caused by gravity. “Over a period of time, you’ll see sagging tissue,” Guyuron says.
Finally, bone changes as we age.
Today, cosmetic surgeons have a host of facial rejuvenation procedures at their disposal to address these aspects of skin aging.
“Newer products help the skin remain rejuvenated, and it is crucial for us to have that as part of our [offering],” Guyuron says. “We can help patients become younger with surgery, and keep them younger and hopefully reduce the potential for future surgeries.”
Fulfilling Expectations
Already an extremely popular nonsurgical way to step up skin rejuvenation, injectables got a boost in April 2015 when the Food and Drug Administration approved Kybella for treatment of moderate-to-severe fat below the chin.
Identical to the deoxycholic acid produced in the body, Kybella actually dissolves the fat cells and is administered in a single treatment of up to 50 injections with up to six single treatments administered no less than one month apart.
During FDA trials with more than 1,000 patients, Kybella showed a 78 percent satisfaction rate, says Dr. Steven Goldman of Beachwood Plastic Surgery.
“You have to choose the right patients,” says Goldman, who is one of 100 national trainers for Allergan, which makes the product. “If they have a lot of loose skin and need a neck lift, they are not candidates for Kybella. Like any injectable, some people get more response and some get less.”
The procedure takes just a couple of minutes in the office, says Dr. Mark Foglietti, of the Cosmetic Surgery Institute in Beachwood. That makes it a great option for patients who are surgery-phobic.
Similarly, patients are increasingly attracted to fillers such as Juvederm to plump areas where loss of volume and fine lines are an issue and can complement other lift surgical procedures. “Today’s fillers are so accurate and can be placed in such a precise manner that you will get a very youthful yet natural look,” Foglietti says.
“People are more open to these procedures because it can be a nice subtle change if done correctly,” he adds. “It’s a way for people to get their feet wet and decide if they want to progress.”
Some physicians are also using the body’s own fat cells as a natural injectable. Harvested and filtered to procure regenerative live fat and stem cells, they’re injected into areas that need more volume. “When the fat takes, it is going to be there for the rest of that person’s life,” Guyuron notes.
In general, fillers require very minimal recovery time. “Most individuals do not swell or bruise,” Guyuron adds. “They can look great for a party that night.”
Fat injections take 10 days to three weeks before desired results are noticeable. And, because more fat is injected than what the body will absorb, patients can expect some swelling during that recovery time.
Digging Deeper
While liposuction remains extremely popular to address unwanted cellulite — bumping up 5 percent last year, according to the American Society of Plastic Surgeons statistics — cosmetic surgeons have added micro-needling, lasering techniques and heating and cooling processes to their repertoire.
In August last year, the FDA approved Cellfina as the first minimally invasive technique to reduce cellulite for two years or more. The one-time procedure treats the structural cause of cellulite: connective bands that weave through fat in the thighs and backside.
The procedure combines suction with a needlelike device (under local anesthesia) that treats the cellulite-causing bands beneath the skin’s surface. “It cuts the bands and stops the cellulite,” Goldman says. “Early results have been outstanding.”
Most people go back to work the next day.
“But it is not an eraser,” Goldman says. “It will not make all cellulite go away, but it has a very high satisfaction rate.”
Fedele uses microneedling — performed with a penlike device under topical anesthesia — to reach the dermis level of the skin and promote collagen stimulation, which provides elasticity. “This tightens up the skin and can help with texture, decrease pore size and improve fine lines,” Fedele says.
Many patients notice a difference after one treatment, Fedele says, but results often improve with time due to stimulating the collagen. He generally recommends a second treatment four to six weeks after the initial procedure.
Another innovation in fat zapping, truSculpt uses radio frequency heat applied to the skin surface. It is noninvasive, requires no incisions and no anesthetic. “It heats up tissue and that temperature actually kills fat cells,” Fedele explains. “After the fat cells die, your body helps eliminate them.”
By administering a series of four treatments performed at monthly intervals, Fedele estimates a 25 to 30 percent improvement in treated areas such as the hip, plank and thigh area, inner thigh and buttocks. “But you can treat most anywhere,” he says. “The procedure has lots of applications.”
Natural Results with Surgical Advances
Achieving natural results from a face-lift is the ultimate goal of most people who opt for this surgical procedure, which has advanced significantly in recent years.
“The key to a face-lift is you should look better and refreshed, but not different,” says Foglietti, who trademarked the Foglietti Natural Vector Facelift. For the past two decades, Foglietti has studied and evaluated the volume of the face and created a surgical sequence for natural results that can be enhanced with the latest fillers.
“A lot of times, in their attempt to rejuvenate the face, plastic surgeons pull tight to remove various folds completely,” Foglietti says. “That is where distortion happens.” Foglietti chooses to do a natural face-lift and enhance it with fillers such as Juvederm or Voluma. “That has been a huge advance,” he says.
However, the key with any procedure — surgical or minimally invasive — is to select a professional that is certified by and a member of the American Board of Plastic Surgery.
“With all of the new techniques available, everyone is getting on the bandwagon to perform procedures,” Fedele points out.
Goldman emphasizes that medical standards including patient safety and proper patient selection are critical for procedures. “We have all these devices, but for any one device you have to choose the right patient,” he says. “You can’t do the same thing on everyone.”
If you’re wondering whether the procedure performed today will last a decade from now, Guyuron busts a common plastic surgery myth. The fact is, if a face-lift makes you look 10 years younger today — a decade down the road, you’ll still look 10 years younger than you would otherwise.
“It is an investment for a lifetime,” he says.
Getting a Leg Up
Do your legs feel heavy and tired? Do they show signs of aging with varicose veins? Anyone who is experiencing aching, throbbing, cramping, swollen ankles and leg fatigue could be a candidate for endovenous laser ablation, a minimally invasive treatment for varicose veins. Unlike injections, this procedure actually treats the cause of the varicose veins in a less invasive way.
Dr. Patricia Duggan, a vascular surgeon, has been using this procedure for the last 10 years and begins the process with an ultrasound to identify underlying vein problems. “If we find a condition where the vein barrels don’t work well, we have to take care of that problem first in order to take care of the symptoms,” she explains.
Endovenous laser ablation involves a cool touch laser with a long wavelength. Basically, the laser addresses superficial vein issues by cauterizing and closing varicose veins. “We put the laser into the leg at one point, and it does all the work from the inside,” Duggan says.
This is a far cry from the traditional vein procedures that took place in a hospital and involved multiple incisions, postoperative bruising and recovery. Instead, endovenous laser ablation is performed in the office, Duggan says. “People have the surgery, can go to work the next day and can pretty much do any physical activity,” she says. “There are no work or activity restrictions.”
