It’s fairly common for people experiencing the signs of facial aging to think that lifting
their skin will make them look younger.
Of course this perception has resulted in the marketing of “minimally invasive”
lifts, particularly threads and skin heating devices.
Although you may appear to look younger by shifting your cheek skin upward, there’s
more to facial aging then what you see from the outside.
I’ll discuss my approach to helping my patients who are considering a lifting procedure in
my practice.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic & Reconstructive
Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
What is a youthful appearance?
A youthful appearance is characterized by facial balance, definition and vibrant skin.
Throughout my career my approach is to first determine the anatomical issues before developing
a treatment plan.
I am fortunate to have extensive experience in facial bone reconstruction and facial cosmetic
surgery.
As technology advanced, I’ve applied the knowledge from my surgical experience, to
performing nonsurgical procedures.
As I mentioned earlier, when a lot of people first think about facial aging, they think
about skin sagging.
During consultation, patients look in the mirror and lift their skin up to show me how
much better they look.
The question is “when is the right time to perform a lifting procedure such as a facelift?
Let’s begin by understanding the 2 most significant aspects of facial aging.
The first is the appearance of sagging and hollowing caused by bone loss.
My patients are often shocked to learn that facial bone volume diminishes as we age.
This is understandable, since we’ve all been exposed to the marketing of creams and
superficial skin treatments as solutions for the appearance of aging.
Pretty much every product claims to “lift and tighten”.
It’s well established in the medical literature the significance of bone volume loss with
age.
Many people in their 40’s and older become aware of their skin sagging and looking tired.
This is because the underlying bone structure decreasing in size results in less support
for the skin.
There are also many people younger than 40 who come in complaining of their skin sagging.
In actuality, their bone structure has some relative deficiency.
For example, someone can say that they’ve always had a weak chin or they never had good
cheekbones.
In my surgical practice, I have placed a lot of chin and cheek implants.
For the past several years I’ve been very able to achieve comparable results without
surgery.
I accomplish this by performing Structural Volumizing.
Structural volumizing means that with a very specific approach, I can place long lasting
hyaluronic acid fillers such as Juvederm Ultra Plus and Juvederm Voluma directly at the bone
level using blunt cannulas and improve the projection and definition of the facial bone
structure.
Restoration of structure allows the overlying skin to appear more toned and less sagging.
More significantly, the proportions of the face are more balanced.
This is based on the art of seeing the golden ratio.
The golden ratio is the ratio of 1.6:1 and is seen throughout nature.
Many actors and models, who are seen as attractive have facial proportions which are expressed
by the golden ratio.
My patients appreciate the improvement from structural volumizing immediately, since the
actual issue has been addressed.
This is in contrast to the current exaggerated claims of threads and heating devices.
I find it interesting that these procedures claim to make significant improvements, yet
they rely on months of collagen production to get the full benefit.
I find it particularly hypocritical that many of the “patients” who are used to demonstrate
these procedures are overwhelmingly people who don’t actually have a problem or are
considerably younger than the people who would come in for these treatments.
So when is a lifting procedure appropriate?
Well the second most significant aspect of facial aging is soft tissue laxity.
Once again, we have to look past the surface.
When I perform a facelift surgery, I always work on the supporting tissue below the skin
called the “SMAS” which is an acronym for “superficial musculoaponeurotic system”.
This is often simply referred to as “the muscle”.
Whether, I perform a short scar or a deep plane facelift, the SMAS is addressed in order
to allow the overlying skin to be repositioned most effectively.
I have found that my threshold for recommending surgical facelift has been changed from the
benefits of structural volumizing.
This means in general, I perform facelift surgery for patients who are their mid sixties
and older.
I look at it this way; if I were to perform structural volumizing, is the skin laxity
too significant for there to be a benefit?
I perform facelift surgery to reposition sagging tissue.
I educate my patients that bone loss is still an area that can be addressed.
This means that further improvement of facial appearance can be achieved with structural
volumizing.
In fact, I see a lot of people who had facelift elsewhere only a few years prior.
They say that they barely see a difference.
I’m sure they had a perfectly well executed facelift although they feel that the surgeon
didn’t pull them tight enough (which is unlikely).
I perform structural volumizing and they are very happy with the results.
This means that many people who’ve had facelifts in the recent past can potentially delay the
need for another facelift by addressing the underlying bone volume loss with structural
volumizing.
Once volume and definition has been achieved, what can be done for more youthful looking
skin?
Youthful skin is generally views as skin that is smooth, even in color and has a vibrant
glow.
Understanding that the skin is an organ like your heat and lungs means that what’s good
for your body is good for your skin.
Avoiding smoking and excess sun exposure with a good diet, sleep and exercise is a good
foundation.
Much of what I do for my patient’s skin in their 40s and beyond falls in 2 categories:
1) helping the skin from past exposures such as sun damage which causes discoloration and
wrinkling from collagen loss.
2) treating the skin for maintenance of appearance and slowing down of the changes from aging.
There is overlap of these two objectives with the more common procedures I perform.
For example, I use PRP or platelet rich plasma, which is a concentration of the wound healing
cells and growth factors needed when you have an injury.
PRP stimulates the production of collagen and improves the blood supply to the area
being treated.
I place PRP under the skin, which helps the fat cell layers under the skin.
This improves your skin’s glow.
I also combine PRP with hyaluronic acid using a micro-infusion device.
We call this skin boosting and the target is the dermis, which is the skin’s support
structure.
This is particularly beneficial for acne scars and fine lines.
For people with lighter skin, I improve skin discolorations with a Q switch laser, a procedure
we call laser skin toning.
There is essentially no downtime with skin boosting and skin toning.
Closing: If you’re in your 40’s and feel that lifting
your skin results in a more youthful look, think from the inside out rather than from
the outside in.
It’s easy to be influenced by influencers who are selling what they’re paid to promote.
Look for a physician to be your guide who you can trust to be your doctor for the long
term, not just for the deal of the week.
I hope you found this information helpful...thank you for your question