Laser, Needle, Knife ... Or Nothing: A New Series From Narcissista

17 May 2013 at 11:30am

My 45th birthday is less than three weeks away. The thought of which makes me swallow hard.

I’ll pull on my big girl pants and power through, but want something stronger than layer-cake to ease the transition. Before I reach for one more overpriced cream, or take a spontaneous approach to Botox, peels and lasers, I’m going to take a big step back and make a plan.

A plan for what really needs to be done … if anything. Maybe what I really need is a personal trainer or guided meditation? So I’m embarking on an adventure called “Laser, Needle, Knife … or Nothing." Over the course of the next several weeks, I’ll pick the expert brains of cosmetic plastic surgeons, dermatologists and get their take on how to freshen me up to without breaking the bank … or my face.

I’ll start with the trickier areas, like the eyes and the neck/jowl/chin zone, where identifying the problem can be like chasing greased piglets and understanding the treatment options, vague at best. Advances in skin care procedures, smile make-overs and the body will also be covered. Before we begin, let me introduce my face at Ground Zero.

Lighting and make-up can make a big difference, so the most natural shot I could muster was this post gym snap in natural light with nothing on my face. [PHOTO]

My first stop is a visit to Dr. W. Matthew White, Director of Facial Plastic and Reconstructive Surgery at NYU Langone Medical Center. He caught my attention during an interview at the American Society of Aesthetic Plastic Surgeons (ASAPS) when he told me I was thinking about aging the wrong way.

FOR THE FULL LASER, NEEDLE, KNIFE ... OR NOTHING, CLICK TO READ NARCISSISTA.

If you need further proof at just how subtle and complex the aging process is, check out this picture of a young vs. aged face, compliments of Dr. David S. Balle, a like-minded Grosse Pointe dermatologist. Dr. White helps me break this down by explaining there are essentially four layers of facial aging. They don’t all happen at once and where it shows up first – eyes, chin/jowl/neck or skin – depends a lot on genetics, environment and how well you take care of yourself. But, understanding what they are, and how one impacts the other is key to being smart about what your treatment options are.

Dr. White helps me break this down by explaining there are essentially 4 layers of facial aging.  They don’t all happen at once and where it shows up first – eyes, chin/jowl/neck or skin – depends a lot on genetics, environment and how well you take care of yourself.  But, understanding what they are, and how one impacts the other is key to being smart about what your treatment options are.

1. Skin
We all know this, and like a lot of women, I’m certainly no stranger to the age creep of fine lines, unevenness, and brown spots.  Not only is the skin the skin thinner and drier, it’s less elastic due to loss of collagen in the dermis, the middle layer of the skin. Fortunately, the medical community has smorgasbord of effective treatment options from prescription cremes like Retinol, chemical peels and lasers.

2. Volume Loss & Shift
As we get older, we lose fat in places like our cheeks, temples and forehead, while accumulating in others, like the lower face and neck.  But did you know our fat undergoes it’s own continental drift?  Just like pieces of a floating iceberg, your fat can separate and migrate, making the contours of your face less smooth. "This is essentially fat loss, due to either loss of subcutaneous fat or 'shifting' of the fat, but the jury is still out on the actual cause,” says Dr. White.

While there’s no shortage of filler options available (hyaluronic acids, Radiesse, Sculptra and sometimes fat), the bigger question is which one and where to inject.  To be continued…

3. SMAS
The next layer down is the SMAS or superficial muscular aponeurotic system, a muscular layer between the bone and the fat.  During a facelift, this is often the area that plastic surgeons lift.  Dr. White explains why this is important: “After the bony support is lost in the face, the soft tissue canvas of the SMAS sags, similar to removing the supporting poles under a tent."

FOR THE FULL LASER, NEEDLE, KNIFE ... OR NOTHING, CLICK TO READ NARCISSISTA.

4. Bone
Now here’s a surprise that should motivate us all to take our calcium – bony changes impact the eye, nose and jaw.

“As we age bone gets resorbed. The bony eye sockets enlarge and the mandible (jaw) loses vertical height. After you lose that height in the mandible, the neck starts to sag, the mid-face caves in and loses projection,” says Dr. White.

“So Dr. White, where do you see the bulk of my aging issues?” I ask.

“What I see is that you have two different sides to your face and this is very common. The left side of your face is smaller than your right.  As a result, your brow and nasalabial fold are more droopy on the left side because you don’t have the bony support.” Wait … what?

“It’s very important for me as a clinician to note the asymmetries when I’m doing your treatments, because it affects the dosage of Botox and fillers on the smaller side.  But some asymmetry is natural,” says Dr. White.

An additional conversation with noted Beverly Hills cosmetic plastic surgeon, Dr. Brent Moelleken, confirms that indeed, on my left side I have something that sounds like my Native American Indian name; low brow, small eye, flat cheek.

“Asymmetry is a very, very artistic thing. You don’t necessarily want to fix it completely but you want to fix it a little. Maybe you augment the more sunken cheek a little bit more but you don’t get it to the point of the right cheek and unless you’re looking at it aesthetically with the juxtaposition of the cheek, the eye and the brow, you’re going to miss that. Very, very few people are attentive to that detail,” says Dr. Moelleken. This explains why I’ve had inconsistent results with Botox and fillers in the past, with my eyebrows sometimes uneven, like they’re going to fly off of my face.

Later that day, I find an email from Dr. White. Concerned that his clinical honesty had bruised my ego after I peppered him with questions about whether symmetry equals beauty, he gave me the closest thing to Chicken Soup for the Asymmetric Soul; links to good looking asymmetrical celebrities.

I guess if facial asymmetry is good enough for Blake Lively and Ryan Reynolds, it’s good enough for me.  And I’ll keep reminding myself that Picasso’s asymmetrical portraits were works of art.

FOR THE FULL LASER, NEEDLE, KNIFE ... OR NOTHING, CLICK TO READ NARCISSISTA.

Narcissista is New York ad exec, RealSelf community member, mom, wife, and self-described “beauty veteran” Becca Smith whose blog, Narcissista.me, deliciously and incisively examines the intersection of beauty, anti-aging, and loving (and navigating) life.