Q. Still looking aged and currently have time for recovery. Suggestions to attain a long lasting, natural and youthful appearance? Hx.. 54 y/o female lower blephroplasty, 1/2005, biltmore & 30% TCA, 4/2016. I prefer one procedure and I do not want the ongoing maintenance and cost fillers require. Lastly, if one suggests ablative laser as a component of the procedure, can it be done now, prior to Midwest summers? Thank you!
A. Thank you for sharing your photos. They are helpful. From your history and your photos, I see a thin skin patient with facial skin laxity, folds and wrinkles, asymmetric brow positioning, natural facial asymmetry, loss of volume in the lips and cheeks.
Since I do not have the advantage to examine you, I hope you will be helped by the information below. My immediate recommendations are to obtain
consultation with a talented, Board Certified Plastic Surgeon with extensive skills in:
- non-surgical skin tightening using Obagi ZO Skin Health Rx regimen and chemical peels
- non-invasive dynamic wrinkle reduction and brow balancing with Botox / Dysport
- minimally invasive Sculptra injection regimen for skin firming and tightening
- minimally invasive injectables including fillers and / or fat
- Minimally invasive Silhouette Suture Suspension of soft tissues and skin longer duration in brow elevation and upper cheek suspension
- Surgical face and neck lift options, as desired.
The passively relaxing tissues we call aging is a spectrum of many different concerns for the patient. Generally, surgical options will last the longest due to the greater collagen production; an average of 7 years for the face. Many minimally invasive options which generally produce less scar or collagen will last less than this and non-invasive options up to a year. You should consider a plan which provides for you the goals and duration of results you are searching for. I hope this is helpful. I wish you all the best in your journey. Please link to our website for considerably more information.
The beginnings of facial skin laxity start when skin repair diminishes and passive skin aging relaxes downward.
The web of fibrous compartments under the skin loses fat, stretches and elongates developing 5 growing “waves” of skin at points of attachment such as the:
- hooding along the eyes,
- lower eyelid / cheek junction or tear trough / nasojugal fold
- nasolabial fold,
- lateral mouth commissure and marionette folds,
- jowls and neck.
The skin itself is not dissimilar to crepe paper held together by collagen, elastin and other structural molecules which also passively diminish with aging.
Facial Aging are created from the 5 different layers of the skin, fat, muscle and bone. During the first 20 years or so of life, the body genetically determines how to develop and repair a constantly changing “face” including all these layers (as it does elsewhere in the body). Thereafter it remains robust in repairing itself from injury but the accumulation of environmental, health and nutritional exposure will add to the passive inability for the body to care for itself after 30. This is when physical changes such as skin laxity, irregular pigmentation, lines and wrinkles and skin diseases occur. We now have many options to rejuvenate the layer or layers of the face which need care or stimulation to reverse the aging trend.
So, it is important to understand there are 2 layers of the face and neck to rejuvenate; the laxed visible skin AND the sagging soft tissues under the skin.
- The top layer or stratum corneum of the epidermis is the rough, pigmented layer of the skin; creating most of the depth of the wrinkle.
· Exfoliation is best for this using:
· microdermabrasion,
· Retin-A (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper epidermis,
· Some lasers and chemical peels.
2.The second layer is the dermis which thins with aging. The natural collagen, elastin and hyaluronic acid (which hydrate and toughen the skin) are thickened by the use of:
· fillers (Restylane and Juvederm), or
· Retinoids (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper dermal skin cells.
· Sculptra properly managed is the latest sensation in stimulating firming and thickening of the dermis
· PRP (platelet rich plasma) and micro-needling is a promising new technique for dermal firming and dermal/epidermal rejuvenation
. ThermiSMOOTH for non-surgical controlled heat skin tightening, or ThermiTIGHT for minimally invasive, dermal skin tightening.
. Chemical Peels and laser tightening are single, “static” attempts to “jump start” the repair system into forming collagen. They should be performed every 3 months in order to achieve a more dynamic stimulation of the immune system collagen production.
The next layer or fat also thins or droops with age and maybe:
· filled (Restylane and Juvederm), fat grafting or
· redraped (Silhouette InstaLift Suture Suspension, short-scar, traditional, endoscopic face / neck / brow lifts / cheek)
4.The muscle which creases the skin into wrinkles and folds is weakened and rebalanced with
· Botox or similar injectable muscle relaxers like Dysport or Xeomin.
5.Bone also undergoes a dynamic process of resorption, thinning and descent. Options for cosmetic enhancements include:
· implants
· structural fillers, particularly like Radiesse (bone mineral)
· volumizing gel fillers like Juvederm and Restylane
6.Facelift, necklift and forehead lift are surgical procedures which include:
· an incision along the periphery of the tissues
· a suspension or re-positioning of the underlying soft tissues, and
· a redraping of the skin with removal of skin excess.
7. A sub-group to the facelift is the mid-face lift. This is used to detach the soft-tissues of the cheek which have descended, separated and lost volume and suspend them to the lower orbital rim. Generally, the fat pockets under the eyes are trimmed or added to the volume of the cheek and the eyelid skin is redraped.
Don’t forget to protect your skin from the elements! UV blockers, anti-oxidants, pigmentation control and acne / oil reduction will maintain your skin rejuvenation efforts. Consult with a Certified ZO Skin Health Specialist!
Everyone needs one or more layered improvement and in personalized combinations to achieve their optimal result. All surgical, minimally invasive and non-invasive procedures and their combinations should be discussed following a proper examination with a well versed, Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he limited in his skills.
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This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.
Give us a call at 410.602.3322 or email Lauri@DrDeanKane.com and make an appointment soon. We’re located on Reservoir Circle just a block off the Baltimore beltway, convenient to greater Baltimore, Annapolis, the Eastern Shore, Southern Pennsylvania, Delaware and Carroll County.
