Hi everyone, I'm Dr. Amir Karam, I'm a board-certified facial plastic surgeon.
I specialize in facial rejuvenation and really trying to help people look as young as they feel.
Today, we're going to talk about a really important topic,
one that comes up a lot
and that is, are facelifts appropriate for people in their 40s?
So the topics I want to talk about and kind of break down,
this important topic is,
we're going to talk about how the face ages, to put it in context.
We also want to talk about non-surgical treatments, the pros and cons,
and also, we want to talk about what are the specific changes
that would benefit from a surgical intervention
and then finally, I want to talk to you about how I approach
those changes with the surgical procedures that I do in my practice.
So the first part of this discussion is,
how does the face age?
Now regardless of where you are in the aging continuum, there's
certain changes that are consistent across every age category and those are basically,
there's a change in the tone and texture of the skin,
the skin loses collagen elasticity
that affects the dullness and the fine lines and wrinkles of the skin.
That has nothing to do with surgical correction,
that's more about skin care and proper treatment for the actual skin.
Then there's a change in volume.
We start to lose facial fat as we age,
we see this as loss in the temples, under the eyes, above the eyes,
our lips shrink a little bit, the cheeks get a little bit smaller,
these are volumetric changes that happen because of fat loss.
Then the third category is changes that are happening to the fascia of the face.
The fascia is what basically causes the face to maintain a certain shape
and with age, that fascia begins to elongate, and get a little bit distorted
and as a result, we start to see squaring of the jawline,
we start to see jowling,
we start to see the changes of the midface coming down and deepening as the nasolabial fold,
and then finally heaviness in the neck region.
Now those changes are what effectively would require surgical treatment but those changes
normally don't start happening until much later, usually at the
end of the fourth decade, late forties and early fifties.
So now that we know, generally, what I would say typical aging looks like,
It's something that starts, you know, loss of volume changes in the skin and
then finally culminates into a change in the facial shape
normally by the time you're in your late 40s early 50s,
that's when most people come in for
facial rejuvenation surgeries, get things like facelifts, etc.
Now, there's a whole other category of people that start to lose that uh,
you know, their facial shape and start to see signs of aging prematurely.
Those are people that start to see laxity and jowling in their 30s and even early 40s.
There's already, there's already laxity in the neck, laxity in the chin,
these are the people that ultimately we are talking about in this particular video.
What do we do with people who don't fit into the normal aging continuum?
So let's dive into that for a moment.
So if you're in your late 30s and early 40s and
starting to see some of those changes we just talked about,
laxity and uh looseness in the neck, etc,
the typical approach that would be offered to you if you're going to a medical spa,
dermatology practice, and even in many plastic surgery offices,
is you're going to be offered non-surgical treatments.
Now, personally after a decade and a half of treating patients
in that age category with non-surgical treatments,
I've come to the realization that those changes
specifically do not respond well to non-surgical treatments.
Things non-surgically we're talking about, the use of fillers,
we're talking about lasers,
we're talking about radiofrequency devices,
all of which are designed to treat early laxity and to try to lift the face, etc.
The problem with fillers are, you start to put a
bunch of fillers in the in the outer cheeks to try to lift the face up,
we've kind of learned our lessons.
There so those people end up looking, you know, unusual.
They start to get really big, you get that pillow face, that chipmunk cheek,
you know, all those things that fundamentally change the way you look
because remember, the core of this is we want to keep you looking youthfu.
Like you were when before the changes happen, not like a different person.
So fillers, when they're used for purposes of trying to lift,
oftentimes lead to facial distortion.
Things like radiofrequency devices, etc,
what I've recognized and I think the consensus is, um, you know, is pretty in line with this,
is that those things really don't fundamentally work.
What we end up seeing is that you go through several of these treatments
and they're not cheap
and then ultimately, you know, you continue to age through them
so they're not really slowing the aging process down,
nor are they helping correct the aging problems.
The next category, the very popular category, is thread lifts.
We see a lot of these out there and now that's the idea of putting these
dissolvable or non-dissolvable dissolvable strings that have barbed attachments
and you lift up the face and it's supposed to hold things in place.
Some of them are designed to increase collagen production, etc ,
but the net effect of those is that they're very short-lasting,
typically six months, at the most.
Even if you get a subtle change,
you pretty much see the change give way by the time you're six months later
plus they're relatively expensive, they cost between three to six thousand dollars to do
and if you think aboutm, you know,
how long you're going to be if you're in your late 30s and early 40s
and you're going to be doing these treatments that only last several months,
I mean it gets kind of frustrating and very very expensive.
if you think about the aging continuum over a long period of time
so in a nutshell, a lot of those non-surgical treatments, unfortunately,
don't work in correcting the problems that are related to laxity
they do work well for correcting problems related to myofascial volume loss
like a little bit of filler here and there is all good,
but not when it comes to laxity.
So if you see jowling and laxity in your neck,
you're probably not going to get much out of the non-surgical treatments ,unfortunately.
so, in a brief summary of
what are the changes that would lend themselves to effective surgical correction?
Those are, in a nutshell, you're going to see looseness and laxity of the outer fascia,
the midface, jawline and neck,
and I want to emphasize that regardless of where you are in the age continuum,
meaning, if you happen to be prematurely aging or if you're typical aging in your late 40s
or early aging in your 30s and early 40s,
the changes that would lend themselves to surgical correction are always the same.
Those are the things that we're talking about,
fascia that starts up here, that comes down to here, all starts to loosen
and you begin to lose that youthful v-shape jawline,
that nice firm midface with the effaced nasolabial fold, the nasolabial folds get deeper with age,
and then you start to see the hooding around the outer brow,
those are the changes that you want to target with a surgical correction.
Okay, so now that we have thoroughly discussed, you know, what changes are are um, you know,
lend themselves to a surgical correction, we've also talked about how people age.
Now, let's talk about how we can effectively deal with them.
So in my practice, again, as I mentioned,
I came through an evolution of trying non-surgical treatments
and I've now come to the conclusion that those changes that we just discussed,
really are effectively treated surgically
and it doesn't matter what age you are,
if you have them ,we need to fix them surgically in order to give you that youthful shape
and that youthful sense.
So the procedures that I have personally
developed, you know, for this particular type of problem is a procedure called
the Vertical Prevent.
If you are in your late 30s early 40s, and you're starting to see just laxity in your jawline,
laxity in your midface, and the outer brow,
the Vertical Prevent is a surgical procedure that's done under local anesthesia
with iv sedation, will lift everything back up, and you can kind of, you know,
experiment whether this would help you or not by simply putting your fingers
on your outer cheeks and your thumb right here on your jawline
and lifting upward
this kind of upward motion, like that,
will give you a an idea of what that change would look like surgically.
The beauty of the vertical prevent is that it's a vertically based procedure,
so it gives you that natural look.
It doesn't pull the face, it releases the facial tendons and ligaments so that
everything is released and tension-free.
So not only does it look more relaxed and looks more natural, but also lasts very long
and that's really at the end of the day,
when you're in your early 40s or late 30s and you're starting to see these changes,
you don't want to be back on an operating table three, four, five years from now.
You want to give yourself 10, 15 plus years of freedom from
having to see these aging changes happen.
The next procedure that we have for that is,
if you start to see changes happening in the neck,
some people see fullness in here, some people see laxity,
in those cases, I perform a technique called the Vertical Restore
which is basically a Vertical Prevent with the addition of a very directed approach to the neck
so we can get a really firm, sharp jawline, and a smooth neck
and when, you know, you think about that, at the end of the day
the beauty of those procedures are that it liberates you from having to
think and worry about how you are aging
and once it's done, it gives you long-lasting changes, way beyond 10 or 15 years
because the way you're going to age will no longer follow the typical genetics that
we see, you know, in those premature early
stages of aging where things are kind of happening kind of quickly,
and also for when people get into their late 40s and early 50s,
when changes really start happening quickly,
you're going to be guarded against that because of the changes that we make at the tissue level,
so at the end of the day, the advantages are,
its long-lasting effect, it's very natural-looking outcome,
and the fact that it's done under iv sedation and local anesthesia.
When you take all those things together,
it's the right choice for those particular kinds of changes.
So I hope this helped, provide
a sufficient overview and detail about how you should manage the aging process
if you happen to be in your late 30s and early 40s
and starting to see some of these changes,
the idea of this is to help you stay efficient and effective,
not waste money on treatments that aren't going to help you,
that also have risks associated with them
but also give you a sense of hope that there is a procedure and a set
of procedures out there that can really help you address these changes more importantly.
Also if you have friends that would find this information useful, please pass it along.
That's the whole purpose of these videos, to educate and help people
understand these confusing topics a little bit better
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Thanks so much.