Facial Aging - Problems And Solutions
By: M. Hugh Bailey, M.D., FACS
Three things happen with time:
Skin gets thinner and less elastic, causing fine lines
The face deflates (loses volume) as the muscles, fat and bone all shrink. (The nose does not grow; it looks bigger because everything else shrank!)
The skin, muscles, and connective tissues all stretch, causing deep wrinkles, bulging and sagging.
Surgery does not improve skin quality, but there are more effective treatment options than even 10 years ago, with less discomfort and downtime. Combining a range of surgical and non-surgical treatments gives better and more natural results. “When all you have is a hammer, everything looks like a nail.” We see the results of that approach at the grocery store! Overfilled “popsicle” faces, overblown “trout pout” lips, faces that hardly move from too much Botox™ and skin pulled so tight and thin from surgery that it is translucent.
New treatments give equal or better results with less discomfort, toxicity or downtime. For example, current medical-grade skin products for brown discolorations provide better results than prescription-strength hydroquinone without liver toxicity. Strong chemical peels were replaced with full coverage CO2 laser and fractional laser, with less color change and risk of scarring. Now RF (radio frequency) microneedling gives laser-like results with less discomfort and without the 7-10 day downtime.
Fat grafting is increasingly popular as a natural, long-lasting alternative to fillers, and the new fillers also offer more options. Over the last twenty years, more surgeons have come to realize that repositioning eyelid fat is a better option than simply removing it, which gets rid of the bagginess but accelerates the hollowing of the eye socket. Similarly, more surgeons are doing deeper facelifts to avoid over-tightening the skin.
Some of my personal favorites are:
EmFace is a device that uses radio frequency energy and electromagnetic stimulation to tone the skin, restore muscles that lift the face, build volume as well, and selectively dissolve fat under the chin. The treatments are painless, with no needles or downtime. After an initial series of weekly 20-minute treatments, a single treatment every few months maintains results. In the forehead, it can also replace Botox™ by strengthening the muscles that oppose the frown muscles.
SecretRF™ is a radiofrequency microneedling device that uses bipolar energy for more precise delivery, avoiding fat destruction. A series of SecretRF™ treatments will give the same collagen/elastin stimulation and skin tightening as fractional laser treatments with less discomfort and little to no downtime.
Fat repositioning blepharoplasty (eyelid tuck). For over 20 years, I have lifted the upper portion of the cheek fat as part of this surgery and blended it with the eyelid fat, with no removal. Traditional blepharoplasty removes the bags, but this procedure also fills the hollowing below the eyelid and lifts the junction of the eyelid and cheek skin to a more youthful position.
Subperiosteal facelift - the deepest of “deep plane” facelifts. Not only does it reposition the cheek fat for a youthful contour, but it also lifts and tightens the muscles that lift the corner of the mouth.
The best and most natural corrections involve treating all the problems with different combinations at different ages. Typically:
Teens and twenties: Start by minimizing tissue damage—use medical-grade skincare and SPF 50 mineral-based sunblock daily, avoid smoking and minimize alcohol (repeated puffiness the next day stretches the skin).
Thirties on: Add treatments to slow aging - Botox™ and fillers in moderation, EmFace to lift the face, smooth the brow, and correct chin laxity.
Forties on: Add deeper treatments to skin care products for skin quality—radio frequency (RF) microneedling (or fractional laser and chemical peels) to stimulate collagen and elasticity. CoolView laser or IPL for discolorations. EmFace and/or minimal incision/endoscopic face and neck lifts for laxity.
Fifties on: More extensive face and neck lifts, with fat grafts or deep fillers for volume loss. There is no upper age limit for surgical treatments in healthy patients—I have done successful facelifts on patients well into their eighties.
Everyone’s face ages differently. Our office will create a customized treatment plan for you, as we offer all the treatment options mentioned, and more. Call our staff at (949) 650 6710 for your consultation with me or visit www.cosmetic-surgeon.com
M. Hugh Bailey, MD FACS is ertified by the American Board of Plastic Surgery and Readers’ Choice Cosmetic Surgeon Winner 2024, Orange County Register