Excess or sagging skin, pigmentation inconsistencies, a lip that loses its line and lines where you don’t want them can happen to anyone.
The good news is we can actually halt aging, says Dr. Bahman Guyuron, who serves as editor-in-chief of Aesthetic Plastic Surgery, the International Society of Aesthetic Plastic Surgery’s official journal. “The results and change we make are permanent,” says Guyuron, whose practice is in Lyndhurst.
He refutes the myth that plastic surgery eventually makes a person look older or the results eventually wear off. “If you take a pair of twins and one has surgical rejuvenation to look 10 years younger and the other does not,” he says, “20 and 30 years later, that sister who underwent surgery will still look 10 years younger.”
Combatting the signs of aging, however, should begin well before they appear, says Dr. Renuka Diwan, of the Laser & Skin Surgery Center in Westlake. “Many people don’t start using skin care until they see damage,” she says. “The sooner you start the better.”
Early prevention begins with children wearing sunscreen and protective covering, while skin care for people in their teens, 20s and 30s can make a remarkable difference, she says. Diwan suggests a regimen for normal skin that includes vitamin C lotion and sunscreen during the day with a Retin-A and vitamin C product at night.
“There’s a time when certain products and procedures are very effective,” Diwan concedes. “Once you enter the next decade, you have to consider other options.”
Fortunately, there are increasing options in the cosmetic surgeon’s toolbox from minimally invasive fillers to improved surgical techniques that boost comfort and reduce recovery downtime.
Last year, Americans spent more than ever before — $16 billion — on cosmetic surgery and minimally invasive procedures, according to a report by the American Society of Plastic Surgeons. There were 17.1 million procedures performed with a trend toward using body fat for shaping (fat grafting) in various parts of the body.
The most common cosmetic surgical procedure was breast augmentation, up 4 percent, followed by liposuction, nose reshaping and eyelid surgery. And while face-lifts had previously fallen off the top five list, it made a return for 2016.
Here’s what’s new and evolving in cosmetic procedures and treatments today.
Cosmetic surgeons performed more than 15 million minimally invasive procedures in 2016, according to the American Society of Plastic Surgeons. While injections of botulinum toxin type A, such as Botox or Dysport, makes up almost half that total, the use of soft tissue fillers have increased almost 300 percent since 2000.
The growth of filler options in the last decade gives plastic surgeons a palette of products with a specific purpose. Volbella, for example, has been available on the market for about six months.
Similar to Juvederm and Restylane, Volbella can be injected closer to the skin surface, which makes it ideal for fine lines and areas such as the cheek and lip, says Dr. Steven Goldman, of Beachwood Plastic Surgery & Medical Spa. The product flows easily and does not absorb water, meaning less swelling, faster recovery and more exact results for lip procedures and other applications.
“What you inject is what you get,” Diwan adds, noting that fillers offer more precision and a chance for more conservative results.
Fillers range in their viscosity, cohesiveness and hydration, explains Goldman.
“Some options like Volbella work better with fine lines,” he says, “while others do better in the cheek [like Voluma] because they are thicker.”
For many patients, fillers can be an appealing foray into cosmetic procedures with visible results and no surgery required.
Used alone to rejuvenate the face, fillers can also accompany surgical procedures such as a face- or eyelid lift or as a maintenance tool to build on surgery’s permanent results as a person ages.
“The good thing about fillers is they are temporary. So if you don’t like it, eventually it will go away,” says Dr. Gregory Fedele, of the Art of Plastic Surgery. “The problem is fillers are temporary. So if you do like the results, you’ll have to get the procedure done again.”
The desire to have luscious, selfie-satisfying lips has grown like the number of teens on Snapchat in the past few years. In 2015, lip augmentation was the second-fastest growing facial procedure since 2000, according to the American Society of Plastic Surgeons.
With surgical and nonsurgical options, lip procedures appeal to young and old alike resulting in a 48 percent increase since 2000.
For women under age 35, there’s definitely a Hollywood effect in play. “The trend is the Khloe Kardashian lip,” says Fedele.
Older women often notice lipstick bleeding or the lip line “falling,” Fedele says. “The signs of an aging lip are thinning, flattening and elongation of the upper lip from the nose to where the lip ends,” he says. “A youthful lip is shorter and has more fullness.”
The solution can be to fill in the vertical lines with products such as Volbella, and add more fullness to the upper and lower lip.
“You can really make someone look younger,” Fedele says. “I’m not talking about an obnoxious lip, but a nice, plumpness.”
For more permanent results, implants can be effective. It involves making two small incisions in the corners of the mouth and passing the implant into place. Generally, it’s two stitches and minimal recovery.
A natural lip is attractive, and there’s a fine line (no pun intended) between going too far with a lip job. Too much fullness can create a duck lip effect. “It’s going to look artificial,” Diwan says. “You want to look enhanced and natural.”
Managing Surface Issues
Advances in technology are helping cosmetic surgeons address issues such as acne scars, varicose veins or unwanted hair.
Microneedling, for example, has been around for more than 20 years to address acne scars and wrinkles. Proven effective, the minimally invasive procedure creates tiny punctures on the top level of the skin that stimulate the body’s production of collagen and elastin. It can help eliminate scars, add firmness and reduce stretch marks.
“It’s a great solution for people who are darker complected and could have pigmentary issues following laser resurfacing,”
It has become so mainstream that in-home microneedling devices are available. Diwan says, these do not offer the same results, however, that you might get from a professional.
Among the top five minimally invasive procedures last year, laser hair removal provides lasting results and is more comfortable now than before, Fedele says.
“We use a brand-new laser that has two different wave lengths to treat a variety of skin types,” he says. In addition, he says, an entire leg or back region can be treated in 15 minutes compared with up to an hour for previous laser treatments.
For those suffering the pain and unsightly blue lines of varicose veins, Food and Drug Administration-approved CoolTouch Laser treatments can be done as an in-office procedure with the guidance of ultrasound and a simple needle stick, says Dr. Patricia Duggan, of Vascular Intervention & Venous Associates.
Patients who have undergone the old “ligation and stripping” procedure experienced several weeks of downtime and recurrence rates of up to 40 percent, Duggan says.
“The laser gently heats the diseased vein and blood is routed to healthier veins,” she says. “The procedure is durable and has very low risk and rapid return to work and play.”
CoolTouch treatment may even be covered by insurance as long as other remedies such as exercise, leg elevation and compression stockings have failed to relieve the pain.
“It’s important to research your doctor prior to making an appointment for varicose vein treatment,” says Duggan, who recommends choosing a board-certified vascular surgeon with seven years of field training.
Lifting Migraines (and the Forehead)
More than a forehead lift with benefits, the migraine surgery Guyuron performs and teaches to doctors internationally can alleviate debilitating headaches and improve patients’ quality of life.
“Migraine medications have side effects,” he says. “Some of them reduce cognitive function and others result in hair loss or weight gain — things people don’t like.”
An adapted forehead lift, Guyuron’s pioneering nerve decompression surgery addresses migraine trigger points.
Patients, who are not responding or tolerating migraine medication and who have at least two migraines per month, are candidates for the procedure. And, if a person desires a more permanent cosmetic improvement to rejuvenate their forehead, the migraine surgery provides that dual benefit.
“I have streamlined the techniques,” he says. “Now a good number of migraine procedures are outpatient under local anesthetic and the patients go home the same day.”
Even when the migraine technique is combined with cosmetic rejuvenation, the surgery can be performed as an outpatient procedure, he says.
“Every year we are making some major improvement in the way we do procedures to minimize risks and improve results,” Guyuron says.
A Naturally Younger Face
Fillers can erase years from the face, but sometimes a face-lift becomes a better option. Recommended for a healthy individual with no medical conditions that impair healing, the best candidates for a face-lift have a positive outlook and realistic expectations.
Dr. Mark A. Foglietti, founder of the Cosmetic Surgery Institute in Beachwood, has 30 years of experience and reminds patients that face-lifts involve anesthesia and recovery time. These days, many of his clients are younger and seeking to make subtle changes before significant signs of aging set in.
But for those who are older, Foglietti pioneered a face-lift technique that helps clients look like a younger version of themselves. Known as the Foglietti Natural Vector Facelift Technique, it individually addresses each layer of muscle and tissue, or vector, that make up the face. By handling each vector separately and carefully, he’s able to address every area of the face and return it to a natural position before gravity took over.
The natural vector face-lift results in an “extremely natural, fresh look to the face,” Foglietti says. “You’re supposed to look younger, not like a different person.”
A Better Backside
A few years ago, the Brazilian butt lift was talked about but not mainstream. In fact, buttock augmentation increased by 26 percent in 2016, according to the plastic surgery association.
While the buttock lift is more common on the East and West coasts, cosmetic surgeons here report more requests from people who feel they’ve “lost their butt” as they age and others who simply desire a fuller backside.
By using a grafting technique that borrows one’s own fat from the flanks or hip area to enhance the bottom, physicians can offer doubly positive results. “It actually slims the hip and waist down while emphasizing the butt and that curve,” Fedele says.
Front and Center
For Dr. Lu-Jean Feng, the greatest recent advance in her practice has been the use of platelet rich plasma. The therapy, which involves drawing an individual’s blood, separating the platelets and reinjecting them, has been used in orthopedics to promote healing of knee and shoulder ligament injuries.
The concentration of protein-rich platelets deliver growth factors that “wake cells up” and spur healing, Feng explains.
While still just a sliver of the overall market, platelet rich plasma is making gains as a component of breast augmentation to promote healing.
Feng uses a combination of platelet rich plasma and adipose derived regenerative cells such as adult stem cells, vascular endothelial cells and vascular smooth muscle cells layered over the existing breast.
“You can really place it strategically in areas of need, so it becomes a much more artistic operation,” Feng says.
Breast augmentation using the body’s own fat-building platelets and stem cells is permanent. “If you gain weight, the breast will get bigger,” she says. “If you lose weight, it will get smaller.”
Platelet rich plasma has also shown potential for patients suffering hair loss. Paired with a nerve-blocking agent to prevent pain, injections into the scalp can spark “exuberant hair growth” within a couple of months, Feng claims.
It can be used following microneedling and laser procedures to improve skin texture and quality by prompting collagen growth. “This is basically cell therapy,” Feng says.
For those seeking breast implants, the “gummy bear” silicone implant has become a popular option.
While more expensive than traditional silicone, the FDA-approved implants are the consistency of gummy bear candies, which better hold their shape and has no inner filling with the potential to leak.
“There is much greater variety today,” Fedele says, relating that the choice of implants have about doubled the number of choices for clients.
Wide, Young Eyes
As we age, sagging skin and extra fat around the eyelids can make us look tired and actually impact vision.
“Surgery can alleviate that weighted feeling,” says Dr. Augustine Kellis, founder and CEO of Ophthalmology & Oculoplastic Surgery in Chardon.
Known as blepharoplasty, the cosmetic surgery procedure on the upper or lower eyelids removes wrinkles and bulges from around the eyes. Sagging eyebrows and eyelids can be corrected at the same time.
“Some patients gain 30 to 40 degrees of [peripheral] vision from blepharoplasty,” he says.
Kellis uses carbon dioxide laser technology to seal blood vessels and lymphatics as he removes fat and skin, which reduces bruising and swelling.
“This also provides more accurate placement of the eyelid because it is not swelling during operation,” he says. “It speeds the surgery tremendously.”
Kellis, who has performed about 75,000 to 80,000 of these procedures, can finish one eyelid in six to eight minutes. “It is an incredible tool,” he says.
This speaks to the advances in cosmetic procedures making treatments feel more accessible by reducing pain and recovery time following surgery.
“The field is exciting and innovative because we are constantly refining these procedures,” Goldman says.
Tiny is trendy — tiny homes, tiny tattoos, tiny dogs.
When it comes to medicine, smaller is often better, with doctors in most every discipline working to make surgical procedures less invasive and recovery times shorter.
That’s the idea behind small incision lenticule extraction, or Smile, a new treatment method for refractive vision problems such as myopia, hyperopia and astigmatism.
While both Lasik and Smile use lasers as a primary tool, the Smile operation creates a pinhole incision on the surface of the eye rather than a flap to provide access to the cornea so it can be properly reshaped.
“Smile is like doing arthroscopic surgery,” says Dr. William Wiley, director of Clear Choice Custom Lasik Center and medical director of Cleveland Eye Clinic.
In traditional Lasik procedures, vision begins improving immediately, but patients can experience fluctuations for three to six months as the flap heals.
Within 24 hours of Smile, patients are often back to regular life including physical activities that would be prohibited following Lasik.
“Most patients are driving within the first 24 hours,” he says. Functional vision returns within two days with optimal vision achieved within four to six weeks. “Women can start wearing makeup within a day or two with Smile, where with Lasik you’d wait a week or two,” Wiley adds.
Patients who were not a candidate for Lasik surgery due to weak or thin corneas or those who suffer from dry eyes may also benefit. “We can preserve the corneal strength [because of no flap incisions],” he says.
Since its approval five years ago in Europe and Asia, more than 750,000 Smile procedures have been performed worldwide. That’s a tiny number compared to 600,000 Lasik surgeries done last year in the U.S.
But, Wiley says, the risks are similar to any other vision correction procedure.“Even contact lenses carry risks,” he says. “They can cause irritation and infection. What’s important is to assess your lifestyle.”