Put Your Best Face Forward
Seeing the effects of age in the mirror is not a fun experience. But aging is a natural progression; the question is, what are we going to do about it? Some folks are resigned to let nature take its course. But others won’t go down that easily. For them there is a whole arsenal of weapons, and they’re eager to chip away at aging, one imperfection at a time.
The eyes are possibly the most important facial feature. They are expressive, sparkling, full of life. Unfortunately, they’re also the first to show age in any number of ways: wrinkles, bags and dark circles. That explains why eye surgeries are among the most common.
the eyes have it
“The center of the face is the first place you look when you meet someone,” says Dr. John B. Holds, ophthalmic plastic surgeon at Ophthalmic Plastic and Cosmetic Surgery in Des Peres. You make a lot of judgments automatically about a person’s level of alertness, intelligence or age by looking at their eyes.”
The eyes are brutally honest, too. “Time and gravity tend to stretch things out. The skin can sag and can create little rolls of skin over the eyes. It happens to most people, slowly, over time,” says Dr. Gabriela Espinoza, a SLUCare surgeon. “If it gets bad enough, that extra skin can hang over the eyelids to the point that you can’t see well.”
darn those genes!
Droopy eyelids and dark circles accompany a few people into the world, Holds says. “You can be born with bags or have a large fat prolapse that sags on the eyelid at a young age. We can simply do fat removal for people in their 20s or 30s.”
Look at your family tree to get a feel for what to expect, Espinoza adds. “Some people never have a problem with sagging eyelids, and others can start having it in their 40s.” Dark circles around the eyes can be inherited, too. “People of some racial backgrounds have darker pigment around the eye area, which is hard to treat,” Holds says. “It requires bleaching creams and other things.”
Dark areas also can be caused by shadows across the tear troughs under the eyes. These can be plumped with dermal fillers, he says. ‘Vascular blush,’ which arises as thinning skin that makes blood vessels more visible, can be hidden with dermal fillers or removed by other methods, such as surgical vein stripping or being treated with intense pulse light or lasers.
the silver bullet
Long a bastion of cosmetic surgery, blepharoplasty is among the simplest and most effective procedures—the most bang for the buck, if you will. “Typically, blepharoplasty involves removal of excess skin around the upper or lower eyelids, and sometimes the repositioning or removal of fat around the eyes to restore a youthful appearance,” Espinoza says. “It is usually a relatively minor procedure that is done on the outside of the eyes, so it is fairly safe. It can be done in an office setting or an operating room under mild sedation, so the patient is not asleep but comfortable.”
Another plus with eye surgery: while the skin is thin, it offers great structures for hiding scars. “The incisions become virtually invisible in the creases of the upper eyelids and right under the lashes of the lower eyelids,” Espinoza says. “Two weeks out from surgery people can walk into work or go down the street and not have many people notice that something has been done.”
The procedure also is gaining ground with men. “Women still predominate, but it is more common these days for men to have blepharoplasty than in the past. I have seen nearly equal numbers in recent years,” she notes. According to the American Society of Plastic Surgeons, the national average cost of surgery is about $3,000 for upper or lower eyelid procedures on both eyes. Treatments for lower eyelids are usually considered cosmetic and not covered by medical insurance, notes Espinoza, but, “the upper eyelids can qualify for insurance coverage. Certain tests are required to show medical necessity to determine how much your vision is affected and how much it can be improved when excess skin is removed.” In these cases, patients get the benefit of both looking better and seeing better.
Even Sir Paul McCartney couldn’t make these look cool: jowls, those sagging skin areas under each cheek that destroy the once-smooth terrain of the chin and jawline. But don’t despair. The experts promise there are solutions.
The word jowls is descended from the Old English ‘chaules’ or ‘jaules,’ which described the fatty cheeks of pigs or wattles of fowl. “You start to develop them right after you are born. Gravity is not your friend,” says Dr. C.B. Boswell, a plastic surgeon at Body Aesthetic Plastic Surgery in Creve Coeur.
“With time and aging, we lose collagen elasticity in the skin, like an elastic band that wears out,” adds Dr. Richard W. Maack, an otolaryngological and facial plastic surgeon at Synergi Facial Surgery in Chesterfield. “Other things that contribute are gravity and genetics—some people start seeing sagging jowls in their 20s and others won’t have them until their 60s or 70s.”
Propensity for forming jowls is inherited, Boswell says. A Mediterranean or African heritage, for example, brings thicker skin that will not sag until later in life. “If you have northern European genetics, you may be looking at a face-lift in your 40s,” he says. Smoking and sun exposure also can damage the skin and underlying tissues and encourage jowl development. “It also depends on whether you have had weight changes over the course of your life,” Boswell says. “People who have had a fairly stable weight will have less damage to the elasticity of the skin.”
And the fairer sex is at a disadvantage here. “Jowls tend to form in women earlier,” Maack notes. “Guys have beards and hair follicles, so their skin is thicker.” Additionally, “women have more issues with bone loss than men because of hormone levels,” says Boswell, and age-related bone loss adds to jowl formation.
no easy fix
Ultimately, Maack says, “The face-lift is the gold standard. We now combine the newest, neatest things out there to produce long-lasting results. We don’t just tighten the skin. We tighten the deep tissue above the muscular layer. It gives you a natural look. The skin doesn’t look pulled, and you don’t get widened scars.”
A pulled, ‘wind-tunnel’ appearance has long been the downside to lower face-lift procedures, the doctors say. “If we only pull up the skin, we get the tightened appearance,” Boswell notes. “What we do now is called a deep-plane face-lift that sets the tension on the underlying tissue.” He says this procedure should more accurately be termed the ‘face-neck lift’ because it helps the face, jawline and neck as one unit. “The deep-plane face-lift is a more complicated surgery. It does have a bit more risk of damage to the facial nerves, but it gives a longer-lasting and more natural appearance.”
a bit of finesse
The scars resulting from face-lifts are tucked around the ears to blend with existing anatomy. For an added touch, the surgeon may remove misplaced fat from under the chin, Maack says. “A little liposuction often will tighten the muscles,” he says. Meanwhile, there are intermediate measures one can take to put off a face-lift (which can cost up to $16,000). In the early stages, falling facial tissues can be addressed through minor tweaks. “At first there are contractions in the muscle that goes from the corner of your mouth down to your jawline,” Boswell says. “The corner of the lower lip starts coming down. A bit of Botox weakens that muscle to prevent the progression of that line.”
And in the middle phase of jowl creation, fillers can replace lost volume under the skin, Maack says. “They’re a great option. We can fill the area in front of the jowl or laterally along the jawline where we lose volume and bone. We also can put fillers in the cheek area, which gives you a mini-lift.
“This is my generation, baby!” sang The Who in 1965. “I hope I die before I get old.” Baby boomers aren’t actually hoping to die now that the years have raced past, but they certainly are choosing not to get old. Exercise and lifestyle habits are keeping them active far beyond the expectations of most of their parents. They have learned that skin care can help them maintain a healthy glow for years longer, too.
“We are people who keep moving and care about how we look,” says Dr. Lawrence E. Samuels of Specialists in Dermatology & Cosmetic Medicine in Chesterfield. “I see many people who are 65 and look like they are still in their early 50s. Today, looking like 40 is the new 50.”
Samuels is one of several St. Louis dermatologists and cosmetic plastic surgeons who have created lines of skin care products that go deeper than over-the-counter creams to rejuvenate and nourish the beloved epidermis. “I wanted to create skin care products based on proven science,” he says. “Healthy skin looks younger.”
His sentiments are shared by Dr. Michele Koo, whose plastic surgery practice is in Kirkwood. “I have been frustrated by the skin care products available to myself, family and patients. They simply did not meet my standards for changing and improving my own or my patients’ skin quality. I have been working with skin and formulating skin care products for decades. I understand the biochemistry of skin cells and how to deliver true medical therapeutics to cells at the different layers of skin.”
“We have it down to the basics,” says Samuels, whose product line is Rx Systems PF. “I tried to create products that don’t require you to use 12 things every day. You need to cleanse your skin, use some type of cream that can repair time and environmental damage, and protect your skin. We have a cleanser, a reparative cream and a facial moisturizer with SPF.”
He also offers many products for specialized needs, such as problems around the eyes or little lines around the lips.
Koo’s products are labeled Dr. Koo Premier Skin Care and also address specific issues and skin characteristics. “I have created six categories of products: a cleanser, a rejuvenation product for wrinkles and poor skin quality, a glow product for uneven pigmentation such as ruddiness and age spots, a boost moisturizer, a gloss topical vitamin to replenish the skin’s nutrients, and a repair product for acne and scars,” she says. “In each category line, there are several products formulated for a specific skin type.”
How do the doctor-branded products differ from over-the-counter products? “You have to ask what the active ingredient is and if there is enough of it,” Samuels says.
Koo adds, “These are not botanicals or cosmetic skin care. I have personally created these products with a chemist based on science and biochemistry. These contain true medical therapeutics in proprietary formulations that cannot be replicated or sold over the counter, yet are gentle and will not irritate the skin because of their unique formulations.”
Maintaining a healthy pH (acid-alkaline balance) protects the skin’s health, she says. “These products are specifically balanced to work within a certain pH to complement each other and synergistically enhance each other for the most effective anti-aging and skin rejuvenation possible,” Koo explains.
The skin has a normal acidic pH, and Samuels says you want products that are going to help maintain that.
The base ingredient that carries the active substance also should be suited for the product’s mission, he says. “That is one place where the over-the-counter sunscreens are pretty good,” he notes. “Those bases don’t penetrate the skin very much, and that’s where you want the active ingredients to stay. If you are using active ingredients like retinol, Vitamin C, alpha lipoic acid, glycolic acid or retinoic acid, you want to use a base formulation that penetrates.”
Premium products, of course, are going to cost more than generics. “These are highly-effective, medically therapeutic skin products, not beauty products,” Koo says.
Samuels acknowledges that they cost more than over-the-counter pharmacy products. “But they are less than the expensive products that over-promise and under-deliver sold in the luxury department stores,” he says.
A fitness regimen can reverse the aging of the skin as well as the muscles, Samuels says. “We can’t make you look 25 again, but if you look at a picture from 10 years ago, we can take you back there. It takes work and you have to exercise, watch what you eat and be careful in the sun.”