Decades of Face: The Eighties, The Reinforcement Decade

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Welcome to Park Avenue
Plastic Surgery Class,

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a podcast where we explore controversies
and breaking issues in plastic surgery.

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I'm your co-host, Doreen Wu,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator, and technology innovator.

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The title of today's episode is
Decades of Face: The Eighties,

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The Reinforcement Decade.

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We're here at the final episode
of our Decades of Face series,

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the end of the line, the eighties. You
already know what I'm going to ask.

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Tell me about the title, Dr. Bass.

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Sure, Doreen.

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The titles in all of these
episodes try to frame the

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perspective about how you should
approach care in this decade.

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In this case, the messaging is
really about the eighties and beyond.

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This is a time to reinforce
whatever work you've done previously

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with treatments and occasionally
with a small surgery.

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And what's going on in this decade?

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It's very different for different folks.

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Some people are very healthy and active,

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some are preoccupied with health issues.

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Some people are really not being
very social or not very much at this

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point, and others are still
very active in social.

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So what does this mean treatment wise?

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It means you pick the amount and type
of treatments based on how much you

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want and need.

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And is that all?

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No, actually selection is also
based on the foundation of

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renovation that you've
built previously in earlier

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decades that will speak to which
features are in good shape and which

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ones need some work.

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What does this entail? How can I figure
out an appropriate treatment plan?

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This, as we've said multiple
times on the podcast,

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points out the importance of careful
planning with a skillful and experienced

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plastic surgeon.

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If your plastic surgeon of past
decades is still practicing,

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they know where you've been
and can see where you're going.

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If that surgeon has retired,

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find an experienced surgeon who's
looking at details and planning

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with you to fulfill your
individual goals and needs.

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Someone who will rightsize a plan
that will help you look your best,

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but be something medically safe and
comfortable to do at this point in your

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life.

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Okay. I'm starting to
get it. At this stage,

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a lot of aging has taken place and
there is some variation to be expected

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based on genetics, lifestyle, overall
health, and previous plastic surgery.

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Still, I feel like I need some idea
of what kind of things to look for.

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What are typical options at this stage?

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That's a great way to look at it.

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It think about the typical
and easy to do options,

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consider somewhat more involved
options if a feature is really

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pronounced,

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and we're going back to our
big categories of treatment.

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So Botox and other neuromodulators
are still helpful at this stage.

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They don't tend to correct
quite as completely due to a

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greater degree of fixed wrinkling,

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but dynamic wrinkles still
respond and at this stage,

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they may actually take a little longer
to wake up and regenerate the muscular

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activity

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than they did when you
were somewhat younger.

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So it's one of the few things that
actually gets a little bit better as we

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age.

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The next big category would be fillers,

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and these are our mainstay of
what we do at this point in

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time. You need to use
more than previously,

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but volume loss is a prominent
feature of aging at this stage,

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so doubling down on
this approach of volume

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restoration pays big
dividends for large volumes

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or more complete corrections.
Some people choose fat grafting.

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Now this is a procedure,

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but it's a minor one with minimal
recovery and minimal surgical

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stress.

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Energy treatments are also
a major player at this

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stage. Skin,

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which is our surface protection against
the elements is definitely not its best

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at this stage and pretty universally shows

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significant signs of aging.

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So anything that globally improves
skin quality will make us look

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markedly younger.

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And this is a very broad range of
treatments from very light treatments to

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somewhat heavy treatments.

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It could be a small series of
no recovery treatments like

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intense pulsed light up to major
release or peels with a week

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of recovery, but still
no surgery or incisions.

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Because of this whole range
of options and even within

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an option,

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the ability to vary the
intensity up and down the scale,

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we can kind dial in what you need based on

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what you've done previously and
how prominent the feature is.

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So as an example, brown spots,

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which were also called
age spots or sun spots,

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would slant treatments one way.

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If we're chasing
predominantly rough texture,

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that will respond to a
whole range of treatments,

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and if we're chasing deep wrinkles,

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we're either going to need a
number of light treatments or

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one heavier recovery based treatment,

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but still no surgery.

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I noticed you haven't said a lot about
skin laxity treatments. Why is that?

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That's very observant.
You're exactly right.

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This is not the main time
point when we're chasing skin

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laxity as a feature.

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It's still worth talking about though
there are people who are having a second

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or third facelift at this time,

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or more typically a neck lift because
that's really the area that gives out.

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The face typically only needs
volume and has reaccumulated only a

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little bit of laxity,

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but the neck usually shows some
hanging skin and some muscle banding,

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and it typically is relapsed to the point
where there's some more obvious need

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for correction. For those who
previously had a facelift,

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a neck lift, the small amount
of laxity may be a minor issue.

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It's not what's really showing what
decade we're in at this stage of the

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game. It's relatively minor,

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so some people choose to focus on
volume and skin surface at this

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point, as I've already mentioned,

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because those are the areas where more
severe findings are typically present

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and the treatments are less
invasive and have a minimum of risk.

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But for people who have put
off having a surgical lift,

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they will on occasion choose to
proceed at this point in their early

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to mid eighties. But for many folks,

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this is really more than what they're
looking for at this stage of life.

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I think it makes a lot of sense to not be

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surgically lifting at this
point, although again,

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there are certainly individual exceptions
for people who are very healthy and

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active,

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and I've seen some excellent results
in folks at this stage if they're

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properly selected and
they're good candidates.

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I also noticed that you still haven't
said anything about non-surgical laxity

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treatments. If I'm
trying to avoid surgery,

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isn't this a good option for getting
some degree of laxity improvement?

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Actually, Doreen, the answer is no.

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Let's look at the biology of
how these devices work. I mean,

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when a plastic surgeon
does a surgical facelift,

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excess skin is mobilized and
redrapes smoothly and the

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excess is trimmed away. Some
people respond more completely,

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some less,

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but it's a major change in everyone
because we're just mechanically

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removing that excess skin.

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Non-surgical laxity treatments
simply don't work in this

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fashion. Whether the treatment
is laser, ultrasound,

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radiofrequency, or some
other form of energy,

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the mechanism of action is
creating a controlled thermal

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effect in or below the
skin or at both depths.

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And the body's response to
this biological stimulus

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creates new collagen
and collagen remodeling.

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So collagen removal and
collagen replacement,

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the response to these treatments is
wholly dependent on how effectively your

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body mounts a response to the
stimulus of the treatment.

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Unfortunately, as we age,
this response diminishes,

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which is partly why we show
laxity in the first place,

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and at this point in your eighties,

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it can pretty reliably be
counted on to belittle to none.

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So those who need laxity change
the most are least able to benefit

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from energy treatments for
laxity. In simple terms,

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you can push your skin,

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but your skin has retired 10 or 20 years
earlier and it isn't going to make a

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meaningful response.

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Your skin can heal and do some things
that we want with various aesthetic

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treatments,

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but laxity changes are modest
with energy treatments,

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even when people are in their
forties or fifties at that stage,

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a modest response for the modest
laxity that's likely to be

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present, that's a pretty good fit,

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but at the point where
you're in your eighties,

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it's just not a useful approach anymore.

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Energy treatments for wrinkles
typically don't show quite as good a

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response either as when they're
done in an earlier decade,

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but the response is still robust
enough that these treatments are quite

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useful. But laxity treatments not so much.

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What about biological
treatments like PRP or stem cell

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responses to the stem cells
contained in fat grafting?

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That's a great question because you'd
think that if you are actually giving some

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of the biological mediators
back into the skin,

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that that would make up for
some of the aging change.

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But this is a very complex
process how all of these

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signaling agents,

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growth factors and other
things talk to each other,

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and recent studies have
shown that there's a

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decline in people in their
sixties and beyond in the

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ability to make use of
this kind of signaling

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and create a visible
impact on skin appearance.

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So it doesn't mean that
it's useless at this stage,

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but the response is blunted compared to
doing kind of treatment in your forties

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or fifties.

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Okay. Dr. Bass,

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can you give our listeners some parting
takeaways from this final decades of

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face episode?

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Absolutely. So at this stage,

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some people have given up
on chasing their appearance,

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but other people are still very active.

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So very variable what you're
going to choose to do,

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but in general,

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we're trying to avoid surgery just
because we want to keep it simple,

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not take any unnecessary risks,

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but there are individual exceptions
where a small surgery or even a

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fair size surgery can be very
useful. But overall, again,

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we're trying to support everything like
the little boy with his finger in the

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dyke.

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We're just trying to hold things together
with the simplest things we can get

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away with. So we want to keep
the best appearance we can,

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but keep it simple. However,

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that doesn't always mean
tiny amounts. So for example,

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with filler, it's
non-surgical, it's no recovery,

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but you're not going to get away with a
syringe of filler globally on the face,

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you're going to be doing bigger volumes.

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Surgery's only going to be for people who
are totally healthy and the procedures

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should be limited, not extensive.

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Remember the sensible
priorities always safety

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first, then looking totally natural,

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then the youngest look we can produce

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still, a lot of things can be done at
this stage that are very meaningful,

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and a lot of the non-surgical
treatments like fillers and basic

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skin laser treatments like IPL
can make a drastic difference

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in how old you look.

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Thank you, Dr. Bass for sharing
your insight and expertise with us.

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And thank you to our listeners for joining
us today to finish out our Decades of

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Face series. Stay tuned,

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another series Central to the
Cutting Edge Plastic Surgery.

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We'll be starting very soon.

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Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

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