Looking young at 50 and beyond


By Dr. Robert H. Gotkin

Recalling the 1960s, women around the world wanted to emulate the flawless beauty and sex appeal of Rio de Janeiro’s girl from Ipanema. Sixty years later, women still want the look that was romanticized in song and seek plastic surgeons who can create that timeless image.

As women cross that mid-century mark and deal with peri- and post-menopausal changes in their face and neck – even if they have been availing themselves of neuromodulators and fillers over the years – they yearn to turn back the hands of time. There are many things that plastic surgeons can do to help.

A myriad of factors influences how the face and neck age. First, you cannot escape your genetics or heredity. If you have a thin face, with less fat, you tend to have more and earlier skin laxity in the face and neck.

If you have a fuller, rounder face, you will generally have more delayed evidence of skin laxity. If you have spent a lot of time in the sun, especially if you have not used sunblock, you will have a lot of sun-induced changes in the skin: lines, wrinkles, sunspots and textural changes in the skin. If you are a smoker, those lines and wrinkles will generally be worse around the mouth.

Most women are aware of the benefits of neuromodulators like Botox and Xeomin in the forehead, between the eyebrows, in the crow’s feet and even around the mouth. These injectable agents can also be used all over the face to improve skin texture and to shape and sculpt the face.

They can be used in the neck to soften the muscle banding that often stands out in the front of the neck. Hyaluronic acid fillers, such as Juvéderm, Restylane and Belotero, can also be used to shape the face. No longer are they advocated simply to fill lines, but are more often used to improve the entire contour of the face – even the shape of the bones.

Hyperdilute Radiesse is another filler that can be used to improve the texture of the skin, soften the “necklace” lines in the neck and the diagonal lines in the chest that often come from sun damage and sleeping on your side.

When there is significant solar elastosis – the sun-induced loss of elastic tissue structural support in the skin – there is a sallow, yellowish appearance with marked, course wrinkles. This is often most apparent around the mouth and in the cheeks.

While injectable neuromodulators and fillers alone can help to some extent, the combination of these agents with fractional CO2 laser skin resurfacing gives the most dramatic and lasting improvement.

The laser skin resurfacing “irons and presses out” the wrinkles, improves the texture and eliminates the sallow yellowish appearance of the skin. Laser resurfacing improves wrinkles even in a way that a facelift cannot achieve.

As time progresses and the effects of aging begin to outpace the results the neuromodulators, fillers and lasers can produce, there are surgical options to enhance your appearance. If your upper eyelid skin seems to be “hooded” and resting on your eyelashes, upper blepharoplasty – a simple procedure to remove excess upper eyelid skin – can be performed.

If the excess is less severe, CO2 laser resurfacing of the upper eyelids may often be just the right choice. Lower eyelid “crinkles” are often best smoothed out by laser resurfacing as well; this can be combined with fillers, once again, to give the best cosmetic result.

If some excess fat under your chin and muscle banding in your neck bothers you the most, a neck lift with Smartlipo (laser-assisted lipo), combined with a platysmaplasty – a procedure to address the muscle banding in the neck – will give you just the results you desire. If the skin laxity and muscle banding in the neck are more severe, and associated with jowls and a loss of the definition of your jawline, it may be time to consider a face and neck lift. This procedure addresses the laxity of your face, jawline and neck and is often combined with blepharoplasty and/or brow lift to enhance the upper part of your face as well.

All of these procedures can be safely performed in the office with varying degrees of recovery. The most important thing to remember is that there are many options to look great beyond 50. After all, who wouldn’t want to be that woman who “when she passes, each one she passes goes ‘Ahh’?”



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