When it comes to maintaining a youthful appearance, no one is immune to the effects of gravity, but that doesn’t mean we have to accept sagging skin and drooping breasts without a fight. We asked local plastic surgeons to share the most effective cosmetic procedures for beating gravity at its own game.
[drooping breasts]
Breast sagging can plague us as we age; or after breastfeeding or weight loss. When your breasts no longer match the rest of your body—or self image—a lift may be the answer for restoring them to a more youthful shape and position. Doctors warn, however, that a lift alone may not be enough for many women.
weigh the options
While women with large breasts may benefit from only a lift, very often the procedure is combined with an augmentation, says Dr. Terry Myckatyn, a Washington University plastic surgeon. A breast lift addresses only nipple position; without also changing breast volume and shape, many women will be disappointed with their results. “Sometimes women come in saying they want a lift because they don’t want to be larger, but they actually also need a small implant to get a more youthful look,” Myckatyn says.
The best way to determine which procedure is right for your chest is to consult with a trained plastic surgeon. Browsing before and after photos can help you narrow down the results you want and help your doctor choose an appropriate course of action. Some physicians are able to photograph your breasts and use software to simulate how they would look after a lift, augmentation or both.
It’s common to do a breast lift and augmentation in stages, says Dr. Christina Plikaitis, a SLUCare plastic surgeon. “Although they are often combined, it can be beneficial to do the lift first without the implant and then, if the patient wants more fullness, you can do an augmentation as a second surgery.”
a matter of time
Before picking up the phone to schedule a breast lift, take a look at your breasts in the mirror. Have the nipples dropped below the level of the crease, where the breast attaches to the chest? If so, says Myckatyn, it’s a good sign you’re a candidate for the procedure. He says women with asymmetrical breasts, where one is lower than the other, may also benefit from a lift.
These telltale signs don’t appear only with advanced age. Although 50- to 70-year-old women have breast lifts, the procedure is most common among women in their 30s and 40s who are anxious to get their bodies back in shape after having children, Plikaitis says. “This is a tool to improve their breasts, which no amount of weight loss or exercise is going to do,” she explains. “It can restore something they feel they lost after pregnancy or weight loss.” Breast lifts also can create symmetry for women who’ve experienced breast changes due to cancer.
what to expect
Think a breast lift is right for you? Be prepared for a bill of at least $5,000 (more to add an implant), and know that insurance typically doesn’t cover the costs. The procedure is performed under general anesthesia, takes less than two hours and usually involves an overnight hospital stay, Myckatyn says. He says most people experience only mild pain and can get back to work in a week and resume exercise in four to six weeks.
It’s important that patients also understand the surgery will leave scars, Plikaitis adds. “We try to put them in inconspicuous areas,” such as around the nipple, from the nipple to the breast crease, or along the crease—all of which a bra will cover. “The tradeoff for the improvement in breast shape and nipple position is scarring. It fades in six to 12 months, and patients are usually very happy with the results.
[sagging face]
Age announces itself on our faces through wrinkles, sagging skin and loss of fullness. Not surprising, a face-lift is among the five most requested cosmetic surgeries, according to the American Society of Plastic Surgeons. Although it won’t turn back the clock to your teen-aged self, a total lift can unveil a younger version of you.
face the facts
When minimally invasive procedures using injectables, ultrasound or radiofrequency are no longer enough to keep your face glowing, it may be time to graduate to a lift, says Dr. William Hart of Hart Cosmetic & Reconstructive Surgery Institute. “There is a spectrum of things to consider when looking at facial rejuvenation. Topical treatments of the face will affect fine-line wrinkling and pigmentation alterations, but that’s about it.” For major gravitational changes that cause loss of volume and sagging skin, a face-lift is typically the best solution, Hart says.
Significant signs of aging appear at different times, depending on a person’s ethnicity, genetics, sun exposure and smoking history. In general, however, women in their 50s and 60s are the most likely candidates for face-lifts, says Dr. Gregory Branham, a Washington University facial plastic surgeon. “When you get to the perimenopausal period, you lose hormonal support, and it’s hard to continue to correct the associated signs of aging without surgery.” There is also an increasing number of men undergoing face-lift procedures.
know the costs
Before going under the knife, consider the financial and physical costs of a face-lift. Branham says while minimally invasive facial rejuvenation procedures are in the $3,000 range, a full face-lift will typically run about $10,000.
It’s also an investment of time. Surgery takes four to six hours, and patients usually go home the same day or after one night in the hospital. Expect to wear a supportive head dressing for a week or two, Branham says, adding “You are typically confined to home for the first week.” There can be bruising, swelling or pinkness for a few weeks, but makeup often can hide those telltale signs. People typically resume normal activities within a month.
“Most people think it’s a bigger, more involved procedure than it actually is,” Hart says. “They are pleasantly surprised at how quickly afterward they get back to feeling good.”
get real
A face-lift can tighten the skin of the jaw and neck to create a sleeker profile with minimal scarring, Branham says. “The higher or lower you move away from the jawline, the less change there will be.” Face-lifts are commonly performed in combination with other procedures, such as eyelid surgery, laser facial peel, liposuction of the jowls, or fat injections in the midface.
Although a face-lift and secondary procedures can reverse the signs of aging, they aren’t a magical time machine. It’s important to set realistic expectations for results. “You’re not going to look 20 if you’re 55, but you’re going to look better,” Branham says. “Most people are pretty realistic. They don’t want to look like a different person. They want to look like themselves, but better.”
[slack jaw]
The only gobbler at a Thanksgiving table should belong to the bird. If excess skin or fat below the jawline is keeping you from feeling thankful, there are several options for taming turkey neck or double chin without investing in a full face-lift.
define the problem
When it comes to the area just south of the jaw, there are two distinct cosmetic issues that plastic surgeons address. The first is double chin, a deposit of fat beneath the chin, which is typically a genetic condition or associated with being overweight. The second issue is turkey neck, or sagging skin caused by a loss of skin elasticity with age.
“With double chin, the person has an extra fat pad but has good skin tone,” says Dr. Brock Ridenour of Ridenour Plastic Surgery. “Turkey neck, on the other hand, is sagging skin, sometimes combined with fat.”
seeing double
People struggling only with a double chin can take advantage of a new non-invasive procedure called Kybella. This FDA-approved injection uses deoxycholic acid to destroy fat cells. Most patients need two to four treatments, spaced one month apart, to get the desired results. “You avoid all of the costs of surgery,” Ridenour says. The first injection is about $1,200 and then goes down with subsequent treatments. There is minimal pain, short recovery and only a moderate risk of bruising, says Dr. Joseph Muccini of MidAmerica Skin Health & Vitality Center.
Although this new treatment is getting a lot of attention, Muccini warns that it has limitations. “This is a good technique for a limited problem,” he says. “It addresses fat under the chin, not a turkey neck. If someone thinks it will take 30 years off their neck, they may be very disappointed.”
gobble, gobble
For those wanting to get rid of turkey neck, a skin-tightening procedure is required. People who have minor looseness of the skin may benefit from a noninvasive option using radiofrequency or ultrasound technology, such as Thermage or Ulthera, that applies controlled heat to cause the skin to contract. It can be combined with Kybella for a more comprehensive result without surgery.
“A lot of people are really interested in doing procedures with less downtime, less risk and no visible incisions,” Ridenour says. “Sometimes you have to do more than one thing, but you can create a nice-looking neck without operating if you’re creative and execute a good plan.”
Patients with looser skin may need to undergo a minimally invasive procedure where a laser is inserted under the skin to dissolve fat and tighten the skin at the same time, Muccini says. Unlike non-invasive heat technology, the laser can cause minor bruising and require three to four days of healing. “There is minimal aggravation, and it involves less risk and recovery than a face-lift,” Muccini says.
By the time loose neck skin becomes a full-blown wattle, the only option is a face-lift. “It’s very important to understand the limitations of noninvasive and minimally invasive procedures,” Ridenour says. “If you have extra fat and a significant loss of elasticity, then you’ll need an operation to correct the structure of the neck.”
