What to do about face?

Dr. Dean Kane Q & A Q. I’m a Hispanic female who is very lean- 5’5″, 104 pounds. I’m an endurance athlete who has run 2 marathons, numerous halves and am now training for a half ironman. Therefore I don’t have much fat anywhere on my body. I am also in the sun a lot. I’m afraid I’m gonna get wrinkles and jowls from my active lifestyle. I’m considering a mini facelift plus chemical peel? Is this a good option? A. ​ It is difficult to provide personalized recommendations without proper examination. ​ ​It is not apparent that you have much laxity in your face but the exercise and fat loss will present with loss of cheek volume (full cheeks being a typical Hispanic trait). I will list below many of the considerations I review with a patient at consultation. Please review these for yourself with your well experienced Board Certified Plastic Surgeon or Dermatologist. ​ ​Various options for facelifting, minimally and non-invasive facial enhancements and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need. Both surgical and minimally invasive / non-surgical options are listed below. Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material. Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift. Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed. The most popular of the fillers, Restylane and Perlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting “cousin”Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial (“parentheses”) and marionette folds, the brow (“number 11”) lines and fill and lift the cheeks and lateral brow or chin.Voluma is the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!. Non-surgical facial contouring is possible with fillers such as Radiesse, a bone mineral for the nose or cheeks, jaw and chin as well. Sculptra is the latest of the injectibles stimulation collagen at different levels of the skin adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent. Botox and Dysport too have been found to re-balance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles! Dr. Obagi’s new, second generation ZO Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin. Dr. Obagi’s sun blocks contain those elements to reduce UV A,B,C injury and block irregular pigmentation production as well. IPL and fractionated lasers such as CO2 and erbium and now RF(radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation. If you can pinch more than an inch of skin along the jawline in front of your earlobe, you should consider a surgical option to redrape and remove extra skin. ​ ​This is a lot of information. Base on your photos, consider:
  1. ​Deep cheek volume filling
  2. ​A ZO Skin Health management plan for retinoid and pigment blending with sun block, for correction and prevention of aging skin.
​ ​I hope this has been helpful! All the best!
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