Jan. 23, 2024
Decades of Face: The Fifties, The Landslide Decade
In this fourth episode of our mini-series “Decades of Face,” Dr. Bass guides people in their 50’s who want to take appropriate and immediate action to avoid looking “old.”
This decade is an active time for facial aging, requiring thoughtful effort around a beauty plan with larger and more frequent treatments. For many people at this age, skin laxity, dull skin, volume loss, wrinkles, jowling, muscle banding in the neck, and droopy eyelids are moderate to severe.
While a surgical face and/or neck lift may be necessary for some people, others may still benefit enough from non-surgical treatments such as Ultherapy, Sofwave, MyEllevate or FaceTite.
Find out why developing a coordinated plan of fewer treatments is smarter than chasing individual concerns, and which treatments are best to slow each of the various changes of your 50’s.
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Welcome to Park Avenue
Plastic Surgery Class,
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the podcast where we explore controversies
and breaking issues in plastic
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surgery. 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 50s,
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The Landslide Decade." Dr. Bass,
we're now onto the fifties.
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Tell us where does the title
come from and what does it mean?
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As we discussed, we definitely see
a lot more going on in the forties,
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but the fifties is a very
active time for facial aging.
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This is especially true for women
due to the onset of menopause,
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which has an average age
in the United States of 51
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following this,
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the withdrawal of estrogen takes
a significant toll on facial
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appearance.
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So this decade is the beginning
of the landslide and typical
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major aging changes will show
over the course of the decade,
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everything in the face is moving
in an unfavorable direction,
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usually down and changing
in an unfavorable way,
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a landslide. That's a rough ride.
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There's so much going on and
so much that needs to be done.
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We hoped we'd never get there,
but this is our reality now,
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a lot to consider and decide about.
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So buckle your seatbelt and
get ready for a bumpy ride.
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I'm not really sure I want to
know the answer to this question,
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but I'm going to ask it anyway.
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Can you go over with me the typical
changes that occur in this decade?
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So as I said, it's a
little bit of everything.
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Skin quality is definitely
rougher and duller,
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obviously older skin to
even a casual glance.
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That's thanks again for
women to loss of estrogen,
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which we loved when it was around, and
it's so sad when it's no longer there.
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There's obvious volume loss in the folds,
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cheeks and jawline and
some degree of skin laxity.
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This varies a lot from person to person,
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but there's at least some visible jowl,
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loose skin in the neck
and loosening of the
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jawline and loss of the sharpness
and straightness of the jawline.
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Usually there's some
vertical banding in the neck,
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which is from muscle spreading and
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presence of wrinkles.
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The amount of wrinkling varies a lot
depending on the skin type, smoking,
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and sun exposure, but this
is often a prominent feature,
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at least in certain parts of the face,
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like the crow's feet and
lipstick bleed lines,
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and the eyelids have a multitude
of changes, hanging skin,
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crepiness, wrinkles,
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deepening of the tear trough
that just at a glance make
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you look obviously older.
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So what does all of
this sum up to Dr. Bass?
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Well,
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all of these changes are almost
always moderate to severe.
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They're no longer mild.
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They might've been in our forties
if we were aging pretty well,
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at least at some point in this decade.
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So there's always an
exceptional individual who's
beating time for the moment,
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but to be honest, they're
probably one percenters.
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They're the exception and not
the rule. So really all of us,
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regardless of how good we think we look,
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are showing a number of
obvious aging changes.
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Okay, so what does all of this mean?
How should I be approaching this decade?
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I'm hoping there's a
silver lining to all this.
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It's simple. When a
landslide is coming at you,
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immediate action is required, where
you get caught and swept away,
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no going into the decade that there
will be a time during this decade when
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beauty items are essential to preserve
your appearance and slow the aging
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process where you'll end up
leaving this decade looking old.
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That is certainly reassuring. Alright,
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can you break this down for me so I
understand what kind of treatments are
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typical for most people in their fifties?
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The basis is picking options
for the same four issues.
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We've been talking about having
an organized rational plan that
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coordinates all the modalities,
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and we talk about having a plan
an awful lot on the podcast,
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and in this decade especially
putting some effort into organizing a
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plan really pays big dividends.
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A plan at this stage in the fifties
is going to involve more components
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and bigger components, translated as cost,
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recovery time, doing
things more frequently.
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Aging is no fun,
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but at least we have options that
can make a meaningful difference.
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You'll get more in terms of results
with a rational coordinated plan
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with fewer overall treatments and
less dollars spent than if you chase
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individual
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things without considering what overlap
and combined benefits could be produced
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for multiple issues at once.
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I'm following so far,
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but can you give me an example of
how combining can be more efficient?
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In my marketplace in New York City,
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a lot of people have different
doctors for their laser treatments,
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their surgery, their Botox
and injectable fillers,
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and for skincare.
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There are a number of
ways that experienced
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providers understand
how to combine things.
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And I'll illustrate
this to prove the point.
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Let's say you have a lot of
pigment on your face, sunspots,
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which medically we call solar
lentigos and some redness,
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rosacea or telangiectasias,
little broken blood vessels,
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things like IPL,
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intense pulse light treatments
might be a good choice,
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but if you also have wrinkles,
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there are energy-based options
that will treat all three and there
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are options that don't really address
the wrinkles but will chase redness with
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pigment and others that will chase the
wrinkles and pigment but not the redness.
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Picking the right option will
kill two birds with one stone.
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There are also treatments that
will put a mild laxity improvement
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into the mix. So it's all about what
you need, not what your friend had.
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He or she may have different
needs even at the same age.
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A professional eye can see
this and advise you. Also,
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there are trade-offs
with cost, recovery time,
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number of treatments and
degree of improvement.
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I'm a minimalist by temperament,
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so I'm always looking for the simplest
option that will get you where you need
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to go rather than pulling
the trigger on the big items
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too early.
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You should save them for when you really
need them since they're not going to be
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repeated or not repeated often.
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So what I'm hearing is I need
a plan now more than ever,
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I really want to keep my
looks and my appearance.
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I'll partner with an experienced plastic
surgeon for advice and planning Dr.
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Bass. Now, can you remind me what
the big four categories are again?
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The four categories are skin
quality, volume preservation,
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dynamic control,
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and skin laxity and skin quality is
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something that we sometimes call
skin surface in the old days,
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but more and more nowadays as
being talked about as skin quality.
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These are the same things we've
been chasing early in the aging with
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non-surgical options and early in aging.
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These are easy problems
because they're mild.
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So almost whatever we pick that
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fits in with your lifestyle,
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it fits in with your budget is going
to make a meaningful difference.
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Now the job gets a lot tougher.
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We have to pick and perform
much smarter to get real
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results because the problems
are now bigger in magnitude.
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Let's take these one at a time,
starting with skin quality.
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Tell me about some skin quality
options for your fifties.
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You're going to continue to
use skin products at home,
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but you may have more them
now. Certainly more than one,
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and they really need to be
medical grade skin products.
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A low level skin product from the
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pharmacy or the cosmetic store is
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less likely to really make an impact.
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Almost everybody should have some energy
treatments two to four times a year.
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These are often no recovery treatments
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and there are new superficial
fillers that plump the surface
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layers of the skin and give the skin
a smoother more even appearance.
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And laser and energy-based treatments
are going to chase the pigment and
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redness. As I said,
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they tend to be no recovery or minimal
downtime treatments that are done in a
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series,
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but pretty much these should be universal
at this point for people in their
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fifties, everyone should be
doing two to four a year. I do.
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And treatments for wrinkles?
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There are a lot of options and
it depends heavily on exactly how
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extensive and how deep the wrinkles are.
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Light to medium chemical and laser peels,
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microneedling radiofrequency,
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platelet rich plasma are all
things that are used to chase
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in particular wrinkles as
well as skin quality overall.
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Okay. It's basically an extension of
what most of us are doing in our forties.
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Let's talk about volume now.
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With volume,
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we're moving on from energy
and products and peels to
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injectable fillers and fat grafting.
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When should I consider which?
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Well, it depends which
areas you're treating,
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how many different areas you
need to treat and how much volume
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loss you have.
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The advantage of fillers is that it's
a 15-minute treatment in the exam
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room at the doctor's office,
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usually with no downtime and you
can return immediately to normal
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activities,
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but you're paying for the
filler syringe by syringe.
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And if there are many areas or a great
deal of volume is needed that can
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break the budget after a while.
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Fat has the advantage of
providing a lot of volume all at
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once, which lets you chase many areas.
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It has more durability and does not
need to be repeated as often as the
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injectable fillers,
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but it is a little bit of
a procedure that always
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has a little bit of bruising
and swelling and recovery time.
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So that's kind of the trade-off
and we don't have the same kind
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of precision in shape
control that we get with
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injectable fillers.
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But why do I need volume? I
don't want a fat face per se.
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That's an important point.
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So we all experience
volume loss with aging.
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Adding back volume,
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particularly in this age
group is about restoring
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shape and volume,
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basically putting you back where
you were maybe when you were 35.
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It's universally needed at this stage
and really part of the plan for everyone
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without exception. Now,
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some people may choose to
chase a lot of the areas,
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some people may just chase one or
two of the most prominent areas.
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That's a personal preference,
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but everyone medically could
benefit at this stage of the game.
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At the same time,
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it's a mistake to overdo volume
restoration in order to chase
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laxity.
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Some people are so desperate to
avoid a surgical fix for skin
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laxity that they get pumped up
with more filler than is natural
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looking and they do get a fat
face or an unnatural look,
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and that's a big mistake.
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Everything has its role and trying
to escape other options by overdoing
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something just leaves you unnatural.
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It's obvious to others and the
risk of complications goes up.
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Moving on to the third category,
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can you clarify what you
mean by dynamic control?
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This is a big issue right now again,
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so this is about
neuromodulators. Basically,
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medicines like Botox that are
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injected prevent the nerve signal
from getting to the muscle,
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reducing the resting
tension in the muscle,
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which evens out certain kinds of wrinkles,
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particularly those in the upper face.
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There's some controversy though because
there are some new devices that are
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trying to train muscles
and stimulate them to
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improve aging face appearance
rather than relaxing
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the muscles. And this controversy
has been going on since the 1990s,
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but with the recent introduction of
some devices for the face which are
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being heavily promoted, it's
causing a reexamination.
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This is very new and the jury is
still out and we'll know more.
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But again,
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whatever we decide about
training muscles and stimulating
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00:14:30,341 --> 00:14:31,120
them,
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00:14:31,120 --> 00:14:35,860
relaxing muscles has been the number
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one aesthetic treatment in the US
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00:14:40,810 --> 00:14:44,980
and in the world for the
last two decades pretty much.
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And that's not likely to change
as we get further into the
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21st century.
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00:14:53,330 --> 00:14:57,890
The other important point about this
is is not something that facelift will
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address. So it's part of
the rejuvenation process,
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00:15:02,390 --> 00:15:05,960
the global rejuvenation
plan for your face,
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00:15:06,170 --> 00:15:11,000
whether or not you do a facelift in your
fifties and whether or not you've had
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00:15:11,420 --> 00:15:15,710
a laser or energy-based treatment
for skin tightening or wrinkle
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00:15:15,711 --> 00:15:16,580
improvement.
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00:15:18,260 --> 00:15:21,350
The neuromodulators also,
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even though they're relaxing muscles,
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00:15:23,670 --> 00:15:28,640
can sometimes trick the
forehead muscles into gently
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00:15:28,641 --> 00:15:30,110
pulling up the brow.
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00:15:30,140 --> 00:15:34,280
And this is the predominant
approach for mild brow
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00:15:34,281 --> 00:15:38,060
droopiness and the heyday of brow lifting,
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00:15:38,070 --> 00:15:42,050
particularly for younger
individuals, 50 and younger,
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00:15:43,250 --> 00:15:47,150
is I believe really in its
twilight at this point in time,
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00:15:47,450 --> 00:15:51,170
although it's still used
frequently in older individuals,
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especially laterally.
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00:15:54,200 --> 00:15:58,430
And the last thing about neuromodulators
that's happening is we're getting some
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neuromodulators like the
newly approved Daxxify,
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which have a longer indication from
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00:16:07,701 --> 00:16:11,570
FDA for the duration of effect. And again,
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00:16:11,580 --> 00:16:15,980
this is very new. It's what
everyone's been asking for.
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00:16:15,981 --> 00:16:20,330
The number one thing patients ask for
is more duration so they don't have to
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00:16:20,331 --> 00:16:24,620
come in as frequently, but it's
not while it's been approved,
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00:16:24,621 --> 00:16:27,740
it's not quite on the
market as of this recording.
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00:16:28,400 --> 00:16:30,350
And so we'll figure that
out a little better,
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00:16:30,360 --> 00:16:34,970
how much impact that has on
our planning once it gets
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00:16:34,971 --> 00:16:37,880
to market and we can all use it.
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00:16:39,830 --> 00:16:43,670
Alright, we're getting down to the
real elephant in the room, skin laxity.
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00:16:44,300 --> 00:16:46,790
I try not to look. I try
not to think about it.
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00:16:47,030 --> 00:16:50,630
I thought in my twenties I'd never
consider surgery for facial laxity,
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00:16:50,960 --> 00:16:54,500
but now I look at my face and I'm having
more and more trouble passing off the
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00:16:54,501 --> 00:16:58,940
growing laxity. I hate to say it,
but biology is working its havoc.
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00:16:59,510 --> 00:17:02,480
Kind of a nightmare I hoped I'd
escape and be one of the lucky ones.
267
00:17:03,140 --> 00:17:08,060
I understand we're all dreading the
development of jowls and hanging skin in
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00:17:08,070 --> 00:17:10,280
the cheeks, jawline, and neck,
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00:17:11,810 --> 00:17:16,220
but it's coming for every one
of us. No one will escape.
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00:17:16,250 --> 00:17:20,900
Even if you're a one percenter somewhere
between now and the time you're a
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00:17:20,901 --> 00:17:21,734
hundred,
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00:17:21,980 --> 00:17:26,750
you'll see it and you'll need a
surgical intervention to chase it if you
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00:17:26,751 --> 00:17:28,280
want to look your best.
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00:17:29,000 --> 00:17:32,660
I do a lot of technology research in
the aesthetic industry and I have my
275
00:17:32,661 --> 00:17:35,630
fingers on the pulse of
what's coming currently.
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00:17:35,631 --> 00:17:40,550
I don't see a meaningful substitute
for surgical lifting in the next 10 to
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00:17:40,551 --> 00:17:44,480
15 years. Magazine, TV,
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00:17:44,480 --> 00:17:47,990
and internet ads for liquid
facelifts and filler or
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00:17:48,260 --> 00:17:50,370
energy-based to lifting,
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00:17:50,940 --> 00:17:55,680
have utility in the earliest stages
of aging and to delay surgical
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00:17:55,681 --> 00:17:59,340
lifting as well as for maintenance,
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00:17:59,910 --> 00:18:01,020
but in my opinion,
283
00:18:01,021 --> 00:18:05,370
are not going to give a satisfying
or useful result that supplant
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00:18:05,490 --> 00:18:06,630
surgical lifting.
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00:18:07,620 --> 00:18:12,060
I get it. There are no free lunches,
so sum it up for me. Dr. Bass,
286
00:18:12,120 --> 00:18:13,920
what are the right moves in your fifties?
287
00:18:15,120 --> 00:18:19,890
A lot of variation depending on
when and how much laxity kicks in.
288
00:18:20,430 --> 00:18:23,310
Non-invasive energy options
like Ultherapy and Sofwave
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00:18:24,840 --> 00:18:28,410
may suffice for slowly aging individuals.
290
00:18:28,980 --> 00:18:32,940
Minimally invasive procedures
like MyEllevate, FaceTite,
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00:18:33,330 --> 00:18:37,320
which is an RF minimally
invasive surgical procedure.
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00:18:37,710 --> 00:18:40,650
Precision Tx, which is something similar,
293
00:18:42,720 --> 00:18:47,040
these may work for some, but we're getting
into the range of surgical options,
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00:18:47,070 --> 00:18:48,270
mini lifts,
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00:18:48,360 --> 00:18:53,130
platysmaplasty and similar small surgical
296
00:18:53,131 --> 00:18:58,050
procedures are definitely in the mix
depending where you are in aging and how
297
00:18:58,060 --> 00:19:02,550
you're feeling about it
and facelift and neck lift,
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00:19:04,260 --> 00:19:07,290
it may be the right time
for some individuals,
299
00:19:08,520 --> 00:19:10,980
particularly in the second
half of the fifties.
300
00:19:12,330 --> 00:19:17,160
Brow lifts again in some individuals
are right and not too early,
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00:19:17,700 --> 00:19:21,270
and it depends which brow lift.
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00:19:21,360 --> 00:19:23,280
The endoscopic brow lift,
303
00:19:23,281 --> 00:19:26,250
which is done through small
incisions behind the hairline,
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00:19:26,251 --> 00:19:30,870
the lateral brow lift, which
lifts the outer edge of the brow,
305
00:19:30,871 --> 00:19:35,850
but uses a longer incision
behind the hairline or the direct
306
00:19:35,851 --> 00:19:39,360
brow lift, which is done through
the upper eyelid plasty incision.
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00:19:39,900 --> 00:19:41,700
The coronal brow lift,
308
00:19:41,701 --> 00:19:45,510
which had a very long incision
across the top of the scalp,
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00:19:45,960 --> 00:19:50,670
is largely historical
these days and not commonly
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00:19:50,671 --> 00:19:55,500
used. Certainly if you have
not had a blepharoplasty,
311
00:19:56,700 --> 00:20:01,560
there are very few individuals in
their fifties who would not benefit
312
00:20:01,561 --> 00:20:02,880
from that procedure.
313
00:20:04,530 --> 00:20:07,650
You raised the issue of the
brow. Correct me if I'm mistaken,
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00:20:07,651 --> 00:20:09,540
but doesn't Botox address that?
315
00:20:09,870 --> 00:20:13,080
What else approaches it and how
is it different from my eyelids?
316
00:20:14,010 --> 00:20:18,300
Botox is limited by your
dynamics and your degree of
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00:20:19,080 --> 00:20:19,913
laxity.
318
00:20:19,980 --> 00:20:24,780
Sometimes you'll lift enough and
sometimes even with carefully
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00:20:24,781 --> 00:20:28,110
placed and dosed Botox injections,
320
00:20:28,120 --> 00:20:32,310
you won't lift enough and still
have some droopiness to the brows.
321
00:20:32,850 --> 00:20:34,140
Eyelid surgery,
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00:20:34,860 --> 00:20:37,890
what's called blepharoplasty
or eyelid plasty,
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00:20:39,660 --> 00:20:43,590
peeling of the lower lid, crepeness
fat grafting into the tear,
324
00:20:43,591 --> 00:20:47,460
trough and skin peeling
325
00:20:48,130 --> 00:20:51,340
energy-based treatments,
lid support procedures.
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00:20:51,580 --> 00:20:55,840
These are things that will
chase changes in the eye area
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00:20:55,841 --> 00:20:59,530
itself, but will not move the eyebrow.
328
00:21:00,010 --> 00:21:04,960
So pretty much everybody in their
fifties is medically ready for eyelid
329
00:21:04,961 --> 00:21:08,650
surgery if they've not already done
it in their thirties or forties.
330
00:21:10,630 --> 00:21:15,520
You may not choose to do anything
there, but you would benefit from it.
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00:21:15,521 --> 00:21:18,820
So you decide if it bothers you
enough to be worth the procedure.
332
00:21:19,750 --> 00:21:22,210
This episode definitely
gave me a lot to consider.
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00:21:22,720 --> 00:21:26,680
It seems the whole face and every aging
feature needs to be reassessed and the
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00:21:26,681 --> 00:21:29,470
plan completely revised at
some point in the fifties.
335
00:21:30,040 --> 00:21:33,520
That's exactly right.
We'd like to just coast,
336
00:21:33,580 --> 00:21:37,660
but this is a time to really
reassess, make a new plan,
337
00:21:38,110 --> 00:21:42,460
start to think about when plastic
surgery procedures need to be part of the
338
00:21:42,461 --> 00:21:43,294
plan.
339
00:21:43,810 --> 00:21:47,080
Right. And lastly, before
we conclude Dr. Bass,
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00:21:47,081 --> 00:21:49,660
can you share some important
takeaways for our listeners?
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00:21:50,290 --> 00:21:54,640
As I said in the last decades of
face episode, our mental self-image,
342
00:21:55,540 --> 00:21:59,770
we think we look sort of how
we looked in our twenties.
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00:21:59,771 --> 00:22:02,170
That's what's locked into our brain.
344
00:22:02,590 --> 00:22:04,870
But no matter how well you're aging,
345
00:22:04,871 --> 00:22:07,510
you don't look like that
anymore in your fifties.
346
00:22:07,960 --> 00:22:11,470
We sort of know we're
not exactly the same,
347
00:22:11,471 --> 00:22:14,410
but we don't realize
how much we've changed.
348
00:22:15,100 --> 00:22:19,900
It's okay to like the way you look and
not feel the need to chase aging changes.
349
00:22:20,560 --> 00:22:22,420
But I counsel my patients,
350
00:22:23,290 --> 00:22:27,670
if they don't take significant steps to
maintain their appearance at this point,
351
00:22:28,120 --> 00:22:32,590
they will need big treatments
and procedures to restore their
352
00:22:32,591 --> 00:22:35,740
appearance in short order. Again,
353
00:22:35,741 --> 00:22:39,670
you may never choose to pursue
maintenance or big restoration,
354
00:22:40,120 --> 00:22:43,420
but you end up owning a
lot more aging baggage,
355
00:22:43,690 --> 00:22:48,100
which would take a lot more work to
undo if you ever change your mind.
356
00:22:48,880 --> 00:22:50,800
So it's important to think through things,
357
00:22:50,810 --> 00:22:55,660
be as sure as you can about your
current direction, go or no go.
358
00:22:56,260 --> 00:23:00,190
Don't kid yourself that all
is well. Things are changing.
359
00:23:01,180 --> 00:23:05,890
Somewhat bigger treatments are needed
to maintain and restore aging features
360
00:23:06,280 --> 00:23:09,250
than what you might've been using
in your thirties and forties.
361
00:23:09,760 --> 00:23:14,740
We try to turn the wheel with recurrent
treatments with energy and fillers and
362
00:23:14,741 --> 00:23:17,350
Botox as long as we can get away with it.
363
00:23:17,351 --> 00:23:21,190
But this is a typical time when
we need to take it up a notch.
364
00:23:21,730 --> 00:23:25,930
The good news is we have a
much wider range of treatments
365
00:23:26,350 --> 00:23:30,850
which can be matched to the severity
of your aging changes and your
366
00:23:30,851 --> 00:23:32,620
tolerance for recovery.
367
00:23:33,760 --> 00:23:38,590
And this lets us fit things much more
precisely rather than one size fits all,
368
00:23:38,591 --> 00:23:40,000
like in the old days.
369
00:23:41,560 --> 00:23:44,500
It's important to think about
what you're going to do and when.
370
00:23:44,650 --> 00:23:46,520
Don't bury your head in the sand,
371
00:23:47,060 --> 00:23:51,470
partner with a plastic surgeon who
will help you understand worthwhile
372
00:23:51,471 --> 00:23:56,060
options that will really
make a meaningful change and
373
00:23:56,070 --> 00:23:58,070
what's involved in these.
374
00:23:58,310 --> 00:24:01,100
So you're planning with facts and not
375
00:24:02,240 --> 00:24:06,440
misimpressions of what recovery
might be like for a procedure.
376
00:24:06,441 --> 00:24:09,230
A lot of the procedures
have less recovery time,
377
00:24:09,590 --> 00:24:12,260
especially nowadays than you might expect.
378
00:24:14,600 --> 00:24:17,240
Finally, unless you're good
with age and gracefully,
379
00:24:19,640 --> 00:24:24,590
recognize this is going to be a decade
of action in a multimodality way.
380
00:24:25,520 --> 00:24:26,450
Thank you, Dr. Bass,
381
00:24:26,451 --> 00:24:29,900
for sharing your insight and expertise
with us and helping our listeners gain a
382
00:24:29,901 --> 00:24:34,100
deeper understanding of this pivotal
decade in facial aging. I, for one,
383
00:24:34,250 --> 00:24:37,460
am glad to know that we have a variety
of options available to us in our
384
00:24:37,470 --> 00:24:38,303
fifties.
385
00:24:38,690 --> 00:24:41,000
Thank you, Doreen, for
your great questions,
386
00:24:41,001 --> 00:24:43,280
the things that people
really want to know about.
387
00:24:44,420 --> 00:24:48,080
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.
388
00:24:48,500 --> 00:24:50,720
Follow us on Apple
Podcasts, write a review,
389
00:24:50,780 --> 00:24:52,100
and share the show with your friends.
390
00:24:52,520 --> 00:24:55,610
Be sure to join us next time to avoid
missing all the great content that's
391
00:24:55,620 --> 00:24:59,150
coming your way. If you want to
contact us with comments or questions,
392
00:24:59,151 --> 00:25:00,800
we'd love to hear from you.
393
00:25:00,800 --> 00:25:04,730
Send us an email at podcast@drbass.net
or DM us on Instagram
394
00:25:05,360 --> 00:25:05,750
@drbassnyc.
00:00:00,630 --> 00:00:03,690
Welcome to Park Avenue
Plastic Surgery Class,
2
00:00:03,690 --> 00:00:07,290
the podcast where we explore controversies
and breaking issues in plastic
3
00:00:07,291 --> 00:00:09,750
surgery. I'm your co-host Doreen Wu,
4
00:00:09,960 --> 00:00:13,140
a clinical assistant at Bass
Plastic Surgery in New York City.
5
00:00:13,590 --> 00:00:18,060
I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,
6
00:00:18,330 --> 00:00:20,490
educator, and technology innovator.
7
00:00:21,690 --> 00:00:25,710
The title of today's episode
is "Decades of Face: The 50s,
8
00:00:25,770 --> 00:00:29,820
The Landslide Decade." Dr. Bass,
we're now onto the fifties.
9
00:00:30,150 --> 00:00:33,090
Tell us where does the title
come from and what does it mean?
10
00:00:34,050 --> 00:00:38,340
As we discussed, we definitely see
a lot more going on in the forties,
11
00:00:38,490 --> 00:00:43,020
but the fifties is a very
active time for facial aging.
12
00:00:43,860 --> 00:00:47,820
This is especially true for women
due to the onset of menopause,
13
00:00:48,060 --> 00:00:51,540
which has an average age
in the United States of 51
14
00:00:52,560 --> 00:00:53,550
following this,
15
00:00:53,551 --> 00:00:58,200
the withdrawal of estrogen takes
a significant toll on facial
16
00:00:58,201 --> 00:00:59,034
appearance.
17
00:01:00,720 --> 00:01:05,310
So this decade is the beginning
of the landslide and typical
18
00:01:05,320 --> 00:01:10,200
major aging changes will show
over the course of the decade,
19
00:01:10,500 --> 00:01:14,910
everything in the face is moving
in an unfavorable direction,
20
00:01:15,180 --> 00:01:19,680
usually down and changing
in an unfavorable way,
21
00:01:20,160 --> 00:01:23,100
a landslide. That's a rough ride.
22
00:01:23,110 --> 00:01:26,940
There's so much going on and
so much that needs to be done.
23
00:01:27,570 --> 00:01:31,890
We hoped we'd never get there,
but this is our reality now,
24
00:01:32,640 --> 00:01:34,740
a lot to consider and decide about.
25
00:01:34,741 --> 00:01:37,830
So buckle your seatbelt and
get ready for a bumpy ride.
26
00:01:39,030 --> 00:01:41,940
I'm not really sure I want to
know the answer to this question,
27
00:01:41,970 --> 00:01:43,740
but I'm going to ask it anyway.
28
00:01:44,130 --> 00:01:47,400
Can you go over with me the typical
changes that occur in this decade?
29
00:01:48,540 --> 00:01:50,670
So as I said, it's a
little bit of everything.
30
00:01:51,270 --> 00:01:55,110
Skin quality is definitely
rougher and duller,
31
00:01:55,530 --> 00:01:59,580
obviously older skin to
even a casual glance.
32
00:02:01,140 --> 00:02:04,410
That's thanks again for
women to loss of estrogen,
33
00:02:04,411 --> 00:02:08,910
which we loved when it was around, and
it's so sad when it's no longer there.
34
00:02:09,600 --> 00:02:12,540
There's obvious volume loss in the folds,
35
00:02:12,541 --> 00:02:17,460
cheeks and jawline and
some degree of skin laxity.
36
00:02:17,730 --> 00:02:20,640
This varies a lot from person to person,
37
00:02:21,300 --> 00:02:24,210
but there's at least some visible jowl,
38
00:02:25,050 --> 00:02:29,340
loose skin in the neck
and loosening of the
39
00:02:29,341 --> 00:02:33,540
jawline and loss of the sharpness
and straightness of the jawline.
40
00:02:34,440 --> 00:02:37,260
Usually there's some
vertical banding in the neck,
41
00:02:37,261 --> 00:02:41,580
which is from muscle spreading and
42
00:02:42,570 --> 00:02:44,040
presence of wrinkles.
43
00:02:44,970 --> 00:02:49,710
The amount of wrinkling varies a lot
depending on the skin type, smoking,
44
00:02:49,711 --> 00:02:53,460
and sun exposure, but this
is often a prominent feature,
45
00:02:53,461 --> 00:02:55,440
at least in certain parts of the face,
46
00:02:55,441 --> 00:02:58,110
like the crow's feet and
lipstick bleed lines,
47
00:02:59,440 --> 00:03:04,030
and the eyelids have a multitude
of changes, hanging skin,
48
00:03:04,090 --> 00:03:05,860
crepiness, wrinkles,
49
00:03:05,861 --> 00:03:10,750
deepening of the tear trough
that just at a glance make
50
00:03:10,751 --> 00:03:12,310
you look obviously older.
51
00:03:13,540 --> 00:03:15,790
So what does all of
this sum up to Dr. Bass?
52
00:03:16,390 --> 00:03:16,670
Well,
53
00:03:16,670 --> 00:03:21,580
all of these changes are almost
always moderate to severe.
54
00:03:21,790 --> 00:03:23,800
They're no longer mild.
55
00:03:24,460 --> 00:03:27,880
They might've been in our forties
if we were aging pretty well,
56
00:03:28,180 --> 00:03:30,250
at least at some point in this decade.
57
00:03:30,700 --> 00:03:35,530
So there's always an
exceptional individual who's
beating time for the moment,
58
00:03:36,520 --> 00:03:40,810
but to be honest, they're
probably one percenters.
59
00:03:40,811 --> 00:03:44,950
They're the exception and not
the rule. So really all of us,
60
00:03:44,980 --> 00:03:47,560
regardless of how good we think we look,
61
00:03:47,740 --> 00:03:51,970
are showing a number of
obvious aging changes.
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00:03:53,530 --> 00:03:58,210
Okay, so what does all of this mean?
How should I be approaching this decade?
63
00:03:58,660 --> 00:04:01,000
I'm hoping there's a
silver lining to all this.
64
00:04:01,720 --> 00:04:05,050
It's simple. When a
landslide is coming at you,
65
00:04:05,290 --> 00:04:09,520
immediate action is required, where
you get caught and swept away,
66
00:04:11,350 --> 00:04:15,550
no going into the decade that there
will be a time during this decade when
67
00:04:15,551 --> 00:04:20,500
beauty items are essential to preserve
your appearance and slow the aging
68
00:04:20,501 --> 00:04:24,970
process where you'll end up
leaving this decade looking old.
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00:04:26,080 --> 00:04:28,660
That is certainly reassuring. Alright,
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00:04:28,780 --> 00:04:32,110
can you break this down for me so I
understand what kind of treatments are
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00:04:32,111 --> 00:04:34,210
typical for most people in their fifties?
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00:04:35,500 --> 00:04:38,950
The basis is picking options
for the same four issues.
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00:04:38,951 --> 00:04:43,120
We've been talking about having
an organized rational plan that
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00:04:43,121 --> 00:04:45,520
coordinates all the modalities,
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00:04:46,390 --> 00:04:51,070
and we talk about having a plan
an awful lot on the podcast,
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00:04:52,030 --> 00:04:56,950
and in this decade especially
putting some effort into organizing a
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00:04:56,951 --> 00:04:59,080
plan really pays big dividends.
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00:04:59,710 --> 00:05:04,240
A plan at this stage in the fifties
is going to involve more components
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00:05:04,300 --> 00:05:09,130
and bigger components, translated as cost,
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00:05:09,130 --> 00:05:11,260
recovery time, doing
things more frequently.
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00:05:11,890 --> 00:05:13,240
Aging is no fun,
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00:05:13,241 --> 00:05:17,170
but at least we have options that
can make a meaningful difference.
83
00:05:17,680 --> 00:05:22,360
You'll get more in terms of results
with a rational coordinated plan
84
00:05:23,050 --> 00:05:27,580
with fewer overall treatments and
less dollars spent than if you chase
85
00:05:27,581 --> 00:05:28,480
individual
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00:05:30,370 --> 00:05:34,750
things without considering what overlap
and combined benefits could be produced
87
00:05:34,960 --> 00:05:36,880
for multiple issues at once.
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00:05:37,960 --> 00:05:39,310
I'm following so far,
89
00:05:39,430 --> 00:05:43,180
but can you give me an example of
how combining can be more efficient?
90
00:05:44,170 --> 00:05:46,840
In my marketplace in New York City,
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00:05:46,841 --> 00:05:50,860
a lot of people have different
doctors for their laser treatments,
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00:05:50,861 --> 00:05:55,390
their surgery, their Botox
and injectable fillers,
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00:05:55,390 --> 00:05:58,010
and for skincare.
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00:05:58,010 --> 00:06:00,170
There are a number of
ways that experienced
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00:06:00,171 --> 00:06:04,520
providers understand
how to combine things.
96
00:06:04,580 --> 00:06:07,010
And I'll illustrate
this to prove the point.
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00:06:07,430 --> 00:06:10,730
Let's say you have a lot of
pigment on your face, sunspots,
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00:06:10,731 --> 00:06:15,380
which medically we call solar
lentigos and some redness,
99
00:06:15,980 --> 00:06:19,760
rosacea or telangiectasias,
little broken blood vessels,
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00:06:19,761 --> 00:06:21,140
things like IPL,
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00:06:21,200 --> 00:06:24,830
intense pulse light treatments
might be a good choice,
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00:06:25,970 --> 00:06:27,860
but if you also have wrinkles,
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00:06:27,861 --> 00:06:32,780
there are energy-based options
that will treat all three and there
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00:06:32,930 --> 00:06:37,280
are options that don't really address
the wrinkles but will chase redness with
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00:06:37,281 --> 00:06:42,140
pigment and others that will chase the
wrinkles and pigment but not the redness.
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00:06:42,560 --> 00:06:45,950
Picking the right option will
kill two birds with one stone.
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00:06:47,120 --> 00:06:51,890
There are also treatments that
will put a mild laxity improvement
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00:06:51,920 --> 00:06:56,510
into the mix. So it's all about what
you need, not what your friend had.
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00:06:56,750 --> 00:07:00,080
He or she may have different
needs even at the same age.
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00:07:00,440 --> 00:07:05,210
A professional eye can see
this and advise you. Also,
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00:07:05,240 --> 00:07:08,120
there are trade-offs
with cost, recovery time,
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00:07:08,600 --> 00:07:11,510
number of treatments and
degree of improvement.
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00:07:12,260 --> 00:07:14,240
I'm a minimalist by temperament,
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00:07:14,241 --> 00:07:17,960
so I'm always looking for the simplest
option that will get you where you need
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00:07:17,961 --> 00:07:22,040
to go rather than pulling
the trigger on the big items
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00:07:22,790 --> 00:07:23,623
too early.
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00:07:24,440 --> 00:07:27,830
You should save them for when you really
need them since they're not going to be
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00:07:27,831 --> 00:07:29,960
repeated or not repeated often.
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00:07:31,400 --> 00:07:34,910
So what I'm hearing is I need
a plan now more than ever,
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00:07:35,390 --> 00:07:38,510
I really want to keep my
looks and my appearance.
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00:07:38,660 --> 00:07:42,860
I'll partner with an experienced plastic
surgeon for advice and planning Dr.
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00:07:43,340 --> 00:07:46,070
Bass. Now, can you remind me what
the big four categories are again?
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00:07:47,420 --> 00:07:52,250
The four categories are skin
quality, volume preservation,
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00:07:52,520 --> 00:07:54,110
dynamic control,
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00:07:54,470 --> 00:07:59,260
and skin laxity and skin quality is
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00:07:59,270 --> 00:08:03,440
something that we sometimes call
skin surface in the old days,
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00:08:03,441 --> 00:08:07,340
but more and more nowadays as
being talked about as skin quality.
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00:08:08,180 --> 00:08:12,740
These are the same things we've
been chasing early in the aging with
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00:08:12,741 --> 00:08:16,880
non-surgical options and early in aging.
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00:08:16,910 --> 00:08:19,970
These are easy problems
because they're mild.
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00:08:20,420 --> 00:08:25,070
So almost whatever we pick that
132
00:08:25,071 --> 00:08:26,540
fits in with your lifestyle,
133
00:08:26,660 --> 00:08:30,080
it fits in with your budget is going
to make a meaningful difference.
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00:08:31,040 --> 00:08:33,020
Now the job gets a lot tougher.
135
00:08:33,320 --> 00:08:37,700
We have to pick and perform
much smarter to get real
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00:08:37,701 --> 00:08:40,940
results because the problems
are now bigger in magnitude.
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00:08:42,860 --> 00:08:45,950
Let's take these one at a time,
starting with skin quality.
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00:08:46,400 --> 00:08:49,280
Tell me about some skin quality
options for your fifties.
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00:08:50,480 --> 00:08:53,720
You're going to continue to
use skin products at home,
140
00:08:53,810 --> 00:08:57,720
but you may have more them
now. Certainly more than one,
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00:08:57,990 --> 00:09:01,140
and they really need to be
medical grade skin products.
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00:09:01,170 --> 00:09:05,490
A low level skin product from the
143
00:09:05,491 --> 00:09:10,110
pharmacy or the cosmetic store is
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00:09:10,120 --> 00:09:12,720
less likely to really make an impact.
145
00:09:13,740 --> 00:09:18,630
Almost everybody should have some energy
treatments two to four times a year.
146
00:09:19,140 --> 00:09:22,830
These are often no recovery treatments
147
00:09:24,210 --> 00:09:28,800
and there are new superficial
fillers that plump the surface
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00:09:28,801 --> 00:09:33,420
layers of the skin and give the skin
a smoother more even appearance.
149
00:09:33,750 --> 00:09:37,650
And laser and energy-based treatments
are going to chase the pigment and
150
00:09:37,651 --> 00:09:40,020
redness. As I said,
151
00:09:40,030 --> 00:09:44,430
they tend to be no recovery or minimal
downtime treatments that are done in a
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00:09:44,431 --> 00:09:45,360
series,
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00:09:45,720 --> 00:09:50,670
but pretty much these should be universal
at this point for people in their
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00:09:50,671 --> 00:09:54,150
fifties, everyone should be
doing two to four a year. I do.
155
00:09:54,690 --> 00:09:57,660
And treatments for wrinkles?
156
00:09:57,661 --> 00:10:01,980
There are a lot of options and
it depends heavily on exactly how
157
00:10:01,981 --> 00:10:04,980
extensive and how deep the wrinkles are.
158
00:10:05,910 --> 00:10:09,270
Light to medium chemical and laser peels,
159
00:10:09,750 --> 00:10:11,850
microneedling radiofrequency,
160
00:10:11,851 --> 00:10:16,260
platelet rich plasma are all
things that are used to chase
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00:10:17,010 --> 00:10:21,450
in particular wrinkles as
well as skin quality overall.
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00:10:22,770 --> 00:10:26,580
Okay. It's basically an extension of
what most of us are doing in our forties.
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00:10:26,940 --> 00:10:28,290
Let's talk about volume now.
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00:10:29,460 --> 00:10:30,151
With volume,
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00:10:30,151 --> 00:10:34,590
we're moving on from energy
and products and peels to
166
00:10:34,591 --> 00:10:37,260
injectable fillers and fat grafting.
167
00:10:38,280 --> 00:10:39,690
When should I consider which?
168
00:10:40,470 --> 00:10:42,630
Well, it depends which
areas you're treating,
169
00:10:44,130 --> 00:10:49,050
how many different areas you
need to treat and how much volume
170
00:10:49,051 --> 00:10:49,950
loss you have.
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00:10:50,490 --> 00:10:55,440
The advantage of fillers is that it's
a 15-minute treatment in the exam
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00:10:55,441 --> 00:10:57,510
room at the doctor's office,
173
00:10:58,110 --> 00:11:02,310
usually with no downtime and you
can return immediately to normal
174
00:11:02,311 --> 00:11:03,180
activities,
175
00:11:04,050 --> 00:11:07,950
but you're paying for the
filler syringe by syringe.
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00:11:07,951 --> 00:11:12,720
And if there are many areas or a great
deal of volume is needed that can
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00:11:12,730 --> 00:11:14,670
break the budget after a while.
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00:11:14,970 --> 00:11:19,860
Fat has the advantage of
providing a lot of volume all at
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00:11:19,861 --> 00:11:21,960
once, which lets you chase many areas.
180
00:11:23,400 --> 00:11:28,020
It has more durability and does not
need to be repeated as often as the
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00:11:28,021 --> 00:11:29,280
injectable fillers,
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00:11:30,420 --> 00:11:35,340
but it is a little bit of
a procedure that always
183
00:11:35,341 --> 00:11:38,850
has a little bit of bruising
and swelling and recovery time.
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00:11:40,050 --> 00:11:44,970
So that's kind of the trade-off
and we don't have the same kind
185
00:11:44,971 --> 00:11:49,440
of precision in shape
control that we get with
186
00:11:49,441 --> 00:11:50,790
injectable fillers.
187
00:11:52,140 --> 00:11:56,200
But why do I need volume? I
don't want a fat face per se.
188
00:11:57,190 --> 00:11:58,630
That's an important point.
189
00:11:59,200 --> 00:12:03,280
So we all experience
volume loss with aging.
190
00:12:04,150 --> 00:12:05,650
Adding back volume,
191
00:12:05,651 --> 00:12:10,390
particularly in this age
group is about restoring
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00:12:10,480 --> 00:12:11,620
shape and volume,
193
00:12:11,650 --> 00:12:15,430
basically putting you back where
you were maybe when you were 35.
194
00:12:16,540 --> 00:12:21,520
It's universally needed at this stage
and really part of the plan for everyone
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00:12:21,521 --> 00:12:22,630
without exception. Now,
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00:12:22,631 --> 00:12:26,590
some people may choose to
chase a lot of the areas,
197
00:12:26,591 --> 00:12:30,970
some people may just chase one or
two of the most prominent areas.
198
00:12:30,971 --> 00:12:32,740
That's a personal preference,
199
00:12:33,310 --> 00:12:37,120
but everyone medically could
benefit at this stage of the game.
200
00:12:38,140 --> 00:12:39,250
At the same time,
201
00:12:39,251 --> 00:12:44,140
it's a mistake to overdo volume
restoration in order to chase
202
00:12:44,150 --> 00:12:44,983
laxity.
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00:12:45,460 --> 00:12:50,290
Some people are so desperate to
avoid a surgical fix for skin
204
00:12:50,291 --> 00:12:55,270
laxity that they get pumped up
with more filler than is natural
205
00:12:55,750 --> 00:13:00,010
looking and they do get a fat
face or an unnatural look,
206
00:13:00,580 --> 00:13:02,590
and that's a big mistake.
207
00:13:02,620 --> 00:13:07,570
Everything has its role and trying
to escape other options by overdoing
208
00:13:07,580 --> 00:13:10,450
something just leaves you unnatural.
209
00:13:10,451 --> 00:13:14,500
It's obvious to others and the
risk of complications goes up.
210
00:13:15,460 --> 00:13:17,350
Moving on to the third category,
211
00:13:17,680 --> 00:13:20,680
can you clarify what you
mean by dynamic control?
212
00:13:21,550 --> 00:13:24,220
This is a big issue right now again,
213
00:13:24,910 --> 00:13:29,500
so this is about
neuromodulators. Basically,
214
00:13:29,530 --> 00:13:33,670
medicines like Botox that are
215
00:13:33,671 --> 00:13:37,960
injected prevent the nerve signal
from getting to the muscle,
216
00:13:38,440 --> 00:13:41,230
reducing the resting
tension in the muscle,
217
00:13:41,350 --> 00:13:45,850
which evens out certain kinds of wrinkles,
218
00:13:45,851 --> 00:13:48,100
particularly those in the upper face.
219
00:13:49,810 --> 00:13:53,470
There's some controversy though because
there are some new devices that are
220
00:13:53,620 --> 00:13:57,940
trying to train muscles
and stimulate them to
221
00:13:57,970 --> 00:14:02,860
improve aging face appearance
rather than relaxing
222
00:14:02,861 --> 00:14:07,600
the muscles. And this controversy
has been going on since the 1990s,
223
00:14:07,601 --> 00:14:12,370
but with the recent introduction of
some devices for the face which are
224
00:14:12,371 --> 00:14:17,170
being heavily promoted, it's
causing a reexamination.
225
00:14:17,650 --> 00:14:22,630
This is very new and the jury is
still out and we'll know more.
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00:14:22,960 --> 00:14:24,010
But again,
227
00:14:25,660 --> 00:14:30,340
whatever we decide about
training muscles and stimulating
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00:14:30,341 --> 00:14:31,120
them,
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00:14:31,120 --> 00:14:35,860
relaxing muscles has been the number
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00:14:35,861 --> 00:14:40,750
one aesthetic treatment in the US
231
00:14:40,810 --> 00:14:44,980
and in the world for the
last two decades pretty much.
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00:14:45,730 --> 00:14:50,410
And that's not likely to change
as we get further into the
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00:14:50,411 --> 00:14:51,680
21st century.
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00:14:53,330 --> 00:14:57,890
The other important point about this
is is not something that facelift will
235
00:14:57,891 --> 00:15:02,090
address. So it's part of
the rejuvenation process,
236
00:15:02,390 --> 00:15:05,960
the global rejuvenation
plan for your face,
237
00:15:06,170 --> 00:15:11,000
whether or not you do a facelift in your
fifties and whether or not you've had
238
00:15:11,420 --> 00:15:15,710
a laser or energy-based treatment
for skin tightening or wrinkle
239
00:15:15,711 --> 00:15:16,580
improvement.
240
00:15:18,260 --> 00:15:21,350
The neuromodulators also,
241
00:15:21,770 --> 00:15:23,660
even though they're relaxing muscles,
242
00:15:23,670 --> 00:15:28,640
can sometimes trick the
forehead muscles into gently
243
00:15:28,641 --> 00:15:30,110
pulling up the brow.
244
00:15:30,140 --> 00:15:34,280
And this is the predominant
approach for mild brow
245
00:15:34,281 --> 00:15:38,060
droopiness and the heyday of brow lifting,
246
00:15:38,070 --> 00:15:42,050
particularly for younger
individuals, 50 and younger,
247
00:15:43,250 --> 00:15:47,150
is I believe really in its
twilight at this point in time,
248
00:15:47,450 --> 00:15:51,170
although it's still used
frequently in older individuals,
249
00:15:51,171 --> 00:15:52,730
especially laterally.
250
00:15:54,200 --> 00:15:58,430
And the last thing about neuromodulators
that's happening is we're getting some
251
00:15:58,440 --> 00:16:03,110
neuromodulators like the
newly approved Daxxify,
252
00:16:03,150 --> 00:16:07,700
which have a longer indication from
253
00:16:07,701 --> 00:16:11,570
FDA for the duration of effect. And again,
254
00:16:11,580 --> 00:16:15,980
this is very new. It's what
everyone's been asking for.
255
00:16:15,981 --> 00:16:20,330
The number one thing patients ask for
is more duration so they don't have to
256
00:16:20,331 --> 00:16:24,620
come in as frequently, but it's
not while it's been approved,
257
00:16:24,621 --> 00:16:27,740
it's not quite on the
market as of this recording.
258
00:16:28,400 --> 00:16:30,350
And so we'll figure that
out a little better,
259
00:16:30,360 --> 00:16:34,970
how much impact that has on
our planning once it gets
260
00:16:34,971 --> 00:16:37,880
to market and we can all use it.
261
00:16:39,830 --> 00:16:43,670
Alright, we're getting down to the
real elephant in the room, skin laxity.
262
00:16:44,300 --> 00:16:46,790
I try not to look. I try
not to think about it.
263
00:16:47,030 --> 00:16:50,630
I thought in my twenties I'd never
consider surgery for facial laxity,
264
00:16:50,960 --> 00:16:54,500
but now I look at my face and I'm having
more and more trouble passing off the
265
00:16:54,501 --> 00:16:58,940
growing laxity. I hate to say it,
but biology is working its havoc.
266
00:16:59,510 --> 00:17:02,480
Kind of a nightmare I hoped I'd
escape and be one of the lucky ones.
267
00:17:03,140 --> 00:17:08,060
I understand we're all dreading the
development of jowls and hanging skin in
268
00:17:08,070 --> 00:17:10,280
the cheeks, jawline, and neck,
269
00:17:11,810 --> 00:17:16,220
but it's coming for every one
of us. No one will escape.
270
00:17:16,250 --> 00:17:20,900
Even if you're a one percenter somewhere
between now and the time you're a
271
00:17:20,901 --> 00:17:21,734
hundred,
272
00:17:21,980 --> 00:17:26,750
you'll see it and you'll need a
surgical intervention to chase it if you
273
00:17:26,751 --> 00:17:28,280
want to look your best.
274
00:17:29,000 --> 00:17:32,660
I do a lot of technology research in
the aesthetic industry and I have my
275
00:17:32,661 --> 00:17:35,630
fingers on the pulse of
what's coming currently.
276
00:17:35,631 --> 00:17:40,550
I don't see a meaningful substitute
for surgical lifting in the next 10 to
277
00:17:40,551 --> 00:17:44,480
15 years. Magazine, TV,
278
00:17:44,480 --> 00:17:47,990
and internet ads for liquid
facelifts and filler or
279
00:17:48,260 --> 00:17:50,370
energy-based to lifting,
280
00:17:50,940 --> 00:17:55,680
have utility in the earliest stages
of aging and to delay surgical
281
00:17:55,681 --> 00:17:59,340
lifting as well as for maintenance,
282
00:17:59,910 --> 00:18:01,020
but in my opinion,
283
00:18:01,021 --> 00:18:05,370
are not going to give a satisfying
or useful result that supplant
284
00:18:05,490 --> 00:18:06,630
surgical lifting.
285
00:18:07,620 --> 00:18:12,060
I get it. There are no free lunches,
so sum it up for me. Dr. Bass,
286
00:18:12,120 --> 00:18:13,920
what are the right moves in your fifties?
287
00:18:15,120 --> 00:18:19,890
A lot of variation depending on
when and how much laxity kicks in.
288
00:18:20,430 --> 00:18:23,310
Non-invasive energy options
like Ultherapy and Sofwave
289
00:18:24,840 --> 00:18:28,410
may suffice for slowly aging individuals.
290
00:18:28,980 --> 00:18:32,940
Minimally invasive procedures
like MyEllevate, FaceTite,
291
00:18:33,330 --> 00:18:37,320
which is an RF minimally
invasive surgical procedure.
292
00:18:37,710 --> 00:18:40,650
Precision Tx, which is something similar,
293
00:18:42,720 --> 00:18:47,040
these may work for some, but we're getting
into the range of surgical options,
294
00:18:47,070 --> 00:18:48,270
mini lifts,
295
00:18:48,360 --> 00:18:53,130
platysmaplasty and similar small surgical
296
00:18:53,131 --> 00:18:58,050
procedures are definitely in the mix
depending where you are in aging and how
297
00:18:58,060 --> 00:19:02,550
you're feeling about it
and facelift and neck lift,
298
00:19:04,260 --> 00:19:07,290
it may be the right time
for some individuals,
299
00:19:08,520 --> 00:19:10,980
particularly in the second
half of the fifties.
300
00:19:12,330 --> 00:19:17,160
Brow lifts again in some individuals
are right and not too early,
301
00:19:17,700 --> 00:19:21,270
and it depends which brow lift.
302
00:19:21,360 --> 00:19:23,280
The endoscopic brow lift,
303
00:19:23,281 --> 00:19:26,250
which is done through small
incisions behind the hairline,
304
00:19:26,251 --> 00:19:30,870
the lateral brow lift, which
lifts the outer edge of the brow,
305
00:19:30,871 --> 00:19:35,850
but uses a longer incision
behind the hairline or the direct
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brow lift, which is done through
the upper eyelid plasty incision.
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The coronal brow lift,
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which had a very long incision
across the top of the scalp,
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is largely historical
these days and not commonly
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used. Certainly if you have
not had a blepharoplasty,
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there are very few individuals in
their fifties who would not benefit
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from that procedure.
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You raised the issue of the
brow. Correct me if I'm mistaken,
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but doesn't Botox address that?
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What else approaches it and how
is it different from my eyelids?
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Botox is limited by your
dynamics and your degree of
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laxity.
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Sometimes you'll lift enough and
sometimes even with carefully
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placed and dosed Botox injections,
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you won't lift enough and still
have some droopiness to the brows.
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Eyelid surgery,
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what's called blepharoplasty
or eyelid plasty,
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peeling of the lower lid, crepeness
fat grafting into the tear,
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trough and skin peeling
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energy-based treatments,
lid support procedures.
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These are things that will
chase changes in the eye area
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itself, but will not move the eyebrow.
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So pretty much everybody in their
fifties is medically ready for eyelid
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surgery if they've not already done
it in their thirties or forties.
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You may not choose to do anything
there, but you would benefit from it.
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So you decide if it bothers you
enough to be worth the procedure.
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This episode definitely
gave me a lot to consider.
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It seems the whole face and every aging
feature needs to be reassessed and the
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plan completely revised at
some point in the fifties.
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That's exactly right.
We'd like to just coast,
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but this is a time to really
reassess, make a new plan,
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start to think about when plastic
surgery procedures need to be part of the
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plan.
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Right. And lastly, before
we conclude Dr. Bass,
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can you share some important
takeaways for our listeners?
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As I said in the last decades of
face episode, our mental self-image,
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we think we look sort of how
we looked in our twenties.
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That's what's locked into our brain.
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But no matter how well you're aging,
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you don't look like that
anymore in your fifties.
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We sort of know we're
not exactly the same,
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but we don't realize
how much we've changed.
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It's okay to like the way you look and
not feel the need to chase aging changes.
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But I counsel my patients,
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if they don't take significant steps to
maintain their appearance at this point,
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they will need big treatments
and procedures to restore their
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appearance in short order. Again,
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you may never choose to pursue
maintenance or big restoration,
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00:22:40,120 --> 00:22:43,420
but you end up owning a
lot more aging baggage,
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which would take a lot more work to
undo if you ever change your mind.
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So it's important to think through things,
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be as sure as you can about your
current direction, go or no go.
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Don't kid yourself that all
is well. Things are changing.
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00:23:01,180 --> 00:23:05,890
Somewhat bigger treatments are needed
to maintain and restore aging features
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than what you might've been using
in your thirties and forties.
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00:23:09,760 --> 00:23:14,740
We try to turn the wheel with recurrent
treatments with energy and fillers and
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Botox as long as we can get away with it.
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But this is a typical time when
we need to take it up a notch.
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The good news is we have a
much wider range of treatments
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which can be matched to the severity
of your aging changes and your
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tolerance for recovery.
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And this lets us fit things much more
precisely rather than one size fits all,
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like in the old days.
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It's important to think about
what you're going to do and when.
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Don't bury your head in the sand,
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00:23:47,060 --> 00:23:51,470
partner with a plastic surgeon who
will help you understand worthwhile
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00:23:51,471 --> 00:23:56,060
options that will really
make a meaningful change and
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what's involved in these.
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So you're planning with facts and not
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00:24:02,240 --> 00:24:06,440
misimpressions of what recovery
might be like for a procedure.
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00:24:06,441 --> 00:24:09,230
A lot of the procedures
have less recovery time,
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especially nowadays than you might expect.
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00:24:14,600 --> 00:24:17,240
Finally, unless you're good
with age and gracefully,
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recognize this is going to be a decade
of action in a multimodality way.
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00:24:25,520 --> 00:24:26,450
Thank you, Dr. Bass,
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00:24:26,451 --> 00:24:29,900
for sharing your insight and expertise
with us and helping our listeners gain a
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00:24:29,901 --> 00:24:34,100
deeper understanding of this pivotal
decade in facial aging. I, for one,
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am glad to know that we have a variety
of options available to us in our
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fifties.
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00:24:38,690 --> 00:24:41,000
Thank you, Doreen, for
your great questions,
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the things that people
really want to know about.
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00:24:44,420 --> 00:24:48,080
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.
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00:24:48,500 --> 00:24:50,720
Follow us on Apple
Podcasts, write a review,
389
00:24:50,780 --> 00:24:52,100
and share the show with your friends.
390
00:24:52,520 --> 00:24:55,610
Be sure to join us next time to avoid
missing all the great content that's
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00:24:55,620 --> 00:24:59,150
coming your way. If you want to
contact us with comments or questions,
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00:24:59,151 --> 00:25:00,800
we'd love to hear from you.
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00:25:00,800 --> 00:25:04,730
Send us an email at podcast@drbass.net
or DM us on Instagram
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00:25:05,360 --> 00:25:05,750
@drbassnyc.