To a certain extent – and within reason – that’s true. As you can well imagine, it’s certainly more likely that we’ll get a more youthful look with a more youthful patient. Regarding the longevity of the result, the more healthy the tissue on which we’re working, the more likely it is to retain the results of the surgery, and younger tissue often translates to more healthy tissue. Also, it has been shown that younger people generally tend to be happier with smaller levels of rejuvenation than older people are with even more dramatic levels of rejuvenation.
That being said, volume loss and sun-damaged skin are better treated with volume augmentation and lasers respectively than with a facelift. Both of these conditions tend to show up earlier than the conditions that are best treated with a facelift, those being the effects of gravity, accumulation of fat at the jowl areas, and stretching and shifting of connective tissues beneath the skin.
Remember too, that any invasive procedure will alter the anatomy somewhat. Structures are moved and stitched into a different position, and the nature of some of the operated tissue changes just by virtue of the natural healing process. So the fewer times someone has a lift over the course of their life, the lower the risk of complications.
Chronological age has less to do with age than individual genetics and lifestyle choices. I remember one day when I was operating, I had a 48 year old and a 64 year old back-to-back. The scrub nurse commented that even before the surgery, the 64 year old looked closer to 48 and the 48 year old looked closer to 64. The bottom line is that “how old” we look is becoming less and less a matter of numbers.
Lastly, make sure your doctor is someone whom you can trust to have your best interests in mind. A couple years ago I had a patient from out of town who had been told that she needed several things done including a facelift, and the fees came to well over $17,000. She was a beautiful, fit 36 year old with a slight genetic obliquity under her chin rather than the well-defined angle we associate with a young neck. She also had some early hooding at the upper lids and the beginning of some volume loss between her cheekbones and her nose. She had absolutely no indications for a facelift, much in keeping with most women that young. I gave her the contour she wanted at her neck, restored her upper lids and gave her some volume where she had lost it for way less than what she had been quoted and with much less invasiveness.
In Part I, we covered your best topical products for intercepting the aging of your skin, “AA (anti-aging) creams” notwithstanding. However, there are now “BB (originally blemish balm, then later beauty balm) creams” and “CC (color correcting) creams” that multitask so you don’t have to layer on multiple products.
The term “Beauty Balm” covers a lot of territory, doesn’t it? Technically, we could affix this moniker to just about anything out there, otherwise why would we even bother using it? (Quite frankly, when my face breaks out, the most efficient “beauty balm” I could use would be a thick paste of benzoyl peroxide and a paper bag over my head.) Nevertheless, the conventional wisdom is that a “BB cream” is a product that combines sun protection with some foundation-like coverage.
The difference between a BB cream and a tinted moisturizer with SPF is that the BB cream generally offers more coverage and more sun protection. You want to look for an SPF of at least 20 for a normal business day with minimal sun exposure. Also, since SPF refers only to the UVB rays (the ones that can burn the skin), you also want to have a product that includes UVA ray protection (those are the insidious rays that come through windows, for instance, and don’t burn or tan you, but just quietly destroy your skin). These will either specify “UVA protection” or be labeled “broad spectrum” sun protection. We carry Jane Iredale products because they are anti-inflammatory, eco-friendly, cruelty-free, pure and really effective at making people look wonderful. Her new BB cream, “Glow Time” is just as fabulous as we would have expected with an SPF of 25, UVA protection and coverage that goes from light to concealer-quality, depending on how it’s applied. And as for the original “B”, this mineral-based cream won’t break you out or make you greasy either.
CC creams generally have a slightly lighter texture than BB creams. They contain various ingredients that benefit the skin and will usually have some sun protection. They distinguish themselves by being “color correcting” in that they will have a tint to offset unwanted skin tones. For instance, peach tones generally even the skin and brighten it up if it’s looking dull (too little sleep, anyone?), green or yellow will tone down ruddy skin and lilac will brighten sallow skin. Some CC creams will have a bronzing effect to warm us up a bit. Jane Iredale has a great one, except it’s been around for about eight years, doing what CC creams do without the catchy title. It’s called Dream Tint and comes in Peach, Lilac and Warm Bronze.
There are even DD and EE creams out there. Personally, I can’t wait till the marketing gurus get up to QQ. That could be a literary challenge. And by the time they get to XX, we may not even be able to talk about it!
by Holly Barbour
What is the most direct route to facial beauty? The answer to that absolutely would be healthy and vibrant skin, hands down. We have lights and lasers, radiofrequency and ultrasound, peels and masks galore, but my patients always want to know what is the one best everyday thing they can slap on their faces to ensure the most benefit to their skin. While the one best topical product would be sunscreen (now don’t roll your eyes just because you’ve heard that ten thousand times – it’s true!), there is pretty much a consensus among those of us who devote our careers to faces that some incarnation of a “retinoid” (the original was Retin-A) is right up there next to sunscreen for preservation of your skin’s vitality.
What is so great about retinoids? First of all, they rev up the turnover of skin, so the outer (essentially dead) layer of cells that can make us look opaque and pasty thins out while the deeper layers become thicker and more springy due to the stimulation of collagen. They also act as an anti-inflammatory and break up some of the stickiness of the cells that plug up our pores. The net result is that after about four weeks or so of regular use, the skin starts to look more plump, clear and luminous. With consistent use of a retinoid over time the skin tends to age more slowly, as studies have shown and as I’ve seen in patients who have used a retinoid for decades. PS – It’s never too late to start. Just remember that because of the more rapid exfoliation of the top layer, you’ll be more sensitive to the sun, so always use a good broad-spectrum sunscreen and reapply at least every hour or two.
The most common reason I hear for people not using a retinoid is that it makes them red and flakey. Other people will tell me that they use one every once in a while on a wrinkle or a blemish. While some formulations are so strong that they are best used for spot treatments, the anti-aging benefits of the retinoids are seen with consistent use over the entire face (with the exception of the upper lids). Retin-A was developed about 45 years ago and we’ve come a long way since then in offering formulations for just about everyone. Your physician or aesthetician can help you find the right one for your particular skin.
Also remember that most skins need to build up a tolerance to a retinoid. We advise our patients to start using one every third night for about two weeks, every other night for two weeks and then nightly. To help your already overburdened brain keep track, start on a date that’s divisible by 3, like the 9th or the 21st; later go to evens or odds. At the end of any month with an odd number of days, anything goes! If you already have a good retinoid that’s still too strong, you can dilute the concentration with a little moisturizer or serum.
Dear Dr. Barbour,
I am so exceedingly grateful, and I appreciate what you have done for me. There are no words to express how thrilled I really am! You gave me my face back! I feel pleasure in putting on my make-up and getting ready for the world again. I feel so uplifted!
The really odd thing too, is that no one knows except my husband and a few very close friends. I went back to work after a ten day "vacation" with a new hairstyle, and everyone thinks my new hairstyle makes me look younger. That's how natural I look.
Thank you and your entire staff! You all have been wonderful to me, and I appreciate your excellent care beyond words. When I had a concern, you were very understanding, and made yourself always available to take care of it. I'll be seeing you from time to time for a little enhancement here and there. Dr. Barbour, you are truly an artist, and I am so grateful to you for giving me back my face.
You have made my daughter beautiful once again. She is so happy & I am thrilled.
The Starflower Essentials skin care products are made right here in Sarasota, Florida, although the ingredients are sourced from all over the world. Cherylyn Van Kirk, the alchemist of Starflower, dedicates herself to finding the highest quality ingredients for her products and combining them for super-efficiency without the irritation that can occur with some organic products. Her ingredients are all food-grade, truly organic and cruelty-free. The products have an amazing ability to calm, hydrate and clear without any heaviness or greasiness at all. They are pristinely packaged in glass and have a shelf life of about 18 months in most cases, without any synthetic preservatives at all.
This is a great question and the short answer is, it depends on where it’s going and who’s giving it. Most physicians who are experienced with replacing lost volume in the face are going to have their favorites of course, but different fillers have different attributes, and at least a small armamentarium is necessary to address the needs of different patients and different parts of the face in an individual.
Any injectable must be FDA-approved and must have been ordered directly from the manufacturer to avoid the disasters of “bootleg” products. Beyond that, the particular filler (or fillers) chosen is tailored to the individual’s needs. Then if the physician is skilled, ethical and has an intuitive understanding of facial harmony and proportion, the outcome should look entirely natural.
Almost every week, a new patient will say something to the effect of, “I want to look better, but I’m so afraid of looking ‘worked-on’”. While there are unfortunate examples of what I call “The Look” all around us, it’s important to know that the sort of overdone, vaguely alien appearance that most of us want to avoid never ever needs to happen. Nor do we need to sacrifice a significant improvement for a natural appearance. We can have the best of both worlds -- really.
It goes without saying that extensive training in the head, eyes/eyelids and neck is imperative for a physician who is going to perform any eyelid, facelift or filler procedures. Additionally, aside from performing the procedures well, the physician needs to make an even more basic assessment of just which procedures need to be performed! As basic as that sounds, there are, for instance, facelifts done when the skin is wrinkled and volume has been lost from the face. In these cases, the lift may be OK technically, but the patient still looks tired, weathered or even a bit flattened out. In other cases, fillers may be given as a “lift” when the problem is gravity and a real lift needs to be done.
Fortunately in many cases revision procedures can be done to correct suboptimal results, although they may need to be “staged”, that is, done over time. In some cases involving fillers, I’ve just seen the patient periodically until a poorly placed or overdone filler starts to wear off. Then we start “tweaking” until eventually the effect is what we want.
The most beautiful and natural looking results require the physician to have a distinct talent, an “eye” for beauty. This, like any artistic talent, is inborn and includes, but goes beyond, technical expertise and training. But when your “work” is done well, it won’t look done; you’ll just look great and people will say things like, “You look wonderful! Did you change your hair?”
Oculofacial Plastic Surgeon, Sarasota, Florida
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