Medical & Trade Publications

August 2006

by Amy M. Ortega, M.D.
Medical / Plastic Surgery

Facial Rejuvenation

Summer is here, and many clients are looking in the mirror, wondering what they can do to improve the ravages of the past year. Every day, time passes and we all continue to age. The sun shines, creating beautiful weather but wrinkled skin. And, yes, gravity is working against us every day, pulling everything down! What can be done?!

The aging face

As we age, the skin becomes less resilient. What used to be thick and tight slowly becomes thin and loose. This is primarily because of changes in the quality and amount of collagen in the skin with age. This is very noticeable in the aging face, and appears in the form of droopy brows, sagging eyelids and lower face, deeper furrows in the "smile" and "frown" lines of the face, and laxity of the neck.

Dynamic movements of the face also produce deep wrinkles that become worse with time. Sun exposure compounds this problem, and causes pigmentary changes and fine lines. Finally, gravity pulls everything down, resulting in decreased definition of the jawline common with "jowling" of the lower face.

Skin that has a lot of sun damage can be rejuvenated with chemical peels and intense pulsed light treatments.

Daily maintenance

Although time, gravity, and sun exposure are constantly attacking our skin from all sides, there are things we can do to protect against these effects and maintain the skin. The first and most obvious is to wear protective sunscreen every day, even on cloudy days. This should be a high SPF with a physical sunblock, such as zinc.

To maintain healthy skin, microdermabrasion is a great routine treatment. I recommend microderm with sodium bicarbonate crystals (baking soda), which are finer, safer, and gentler on the skin than the standard aluminum hydroxide crystals typically used.

If a client already has a lot of sun damage, he or she may have fine lines and sun spots on the face that need to be addressed. Two great ways to alleviate these are chemical peels, which can be done in the office, or intense pulsed light treatments, sometimes called Fotofacials. The latter is a simple, in-office, noninvasive laser treatment that can reduce redness and uneven skin pigmentation. Several treatments are generally required for the best results.

Botox® bounty

If a client has or is developing "dynamic wrinkling"—wrinkles created by facial expression, especially between the eyebrows, on the forehead, and the crow's feet areas—then treatment with Botox® can be very helpful in reducing their appearance and preventing them from becoming worse.

Many patients who are not ready for surgery are pleasantly surprised at the relaxing effect of Botox® treatments, which involve tiny injections that selectively weaken muscles of facial expression, preventing the expression wrinkles. Deeper wrinkles can be improved with injections of fillers as well (collagen, etc.).

Beyond lunchtime treatments

At some point, the aging process is no longer improved through simple procedures done during lunch hour. In these cases, significant, noticeable improvement can definitely be achieved with facial cosmetic surgery.

Liven up the lids

The first and perhaps most noticeable way to brighten one's look is through a blepharoplasty (eyelid lift). This procedure reduces the "tired" look around the eyes by removing excess skin and fat, and tightening remaining tissues. Newer techniques are less dependent on the amount of fat removed and instead emphasize the concept of "rearranging" the fat to fill in the hollows for a more natural look.

Blepharoplasty is especially popular with men, since eyelid surgical scars heal so well that they can be nearly invisible even without makeup. If your brows have fallen also, you may consider a brow lift, which now is accomplished through tiny incisions hidden in the hair using an endoscope (small camera).

Mid-facelift magic

If you have deep "smile lines" but are not ready for facelift surgery, you can see a nice improvement with a mid-facelift. This less-invasive procedure is accomplished through the same "nearly invisible" incision below the eyelash line that is used for lower eyelid surgery. A dissolvable device called an Endotine is used to lift the tissues of the cheek, which in turn reduces the appearance of the "smile lines."

Facelift accompaniments

Once the lower face "jowling" and sagging neck have become prominent, a facelift is the best way to go. Facelift incisions heal very nicely and are much less visible than most people think. Most of the incision is hidden in the hairline. A facelift very nicely corrects lower face jowling, improves "frown lines," and tightens the neck. Modern facelift techniques also address the tissues below the skin rather than simply pulling the skin tightly, resulting in a more natural look rather than the "pulled" look of the old days. If symptoms are very mild, clients may achieve correction with a mini-facelift.

The patient in the photos is shown before and after a facelift, neck lift, mid-facelift, and lower eyelid surgery. She has regained a smooth, youthful neck and jawline. It is actually true that a facelift can easily help you to look 10 years younger... and sometimes more!

Amy M. Ortega, M.D., is a board-certified, double-fellowship trained cosmetic plastic surgeon with special interest in cosmetic surgery of the face, breast and body. Her office is located in Atlanta, GA. To reach her, call (404) 751-2500. For more information ABOUT DR. ORTEGA, visit her website, www.ASAbeautiful.com.