20 Ways to Look 10 Years Younger in 2014

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The Fall 2013 issue of New Beauty Magazine has an article entitled, "20 Ways to Look 10 Years Younger."  We offer most of these at Persky Sunder Facial Plastic Surgery.  We will go over each item and give you our insights into the anti-aging treatments.

1.  Erasing fine lines and wrinkles.  The three US FDA approved neuromodulators, Botox, Dysport, and Xeomin are all very good at treating lines and wrinkles of the upper third of the face including the vertical "11" lines of the glabella, horizontal forehead lines, and Crow's feet lines.  In addition, these neuromodulators can be used to treat "Bunny lines" at the top of the nose, enlarged masseter muscles, chin "orange peel" texture, platysmal bands of the neck, and lifting the jawline (Neferetti Lift).

2.  Fix hollow temples.  We prefer the use of fillers such as Sculptra, Radiesse, Juvederm, and most recently the newest filler Voluma to correct hollowed temples, which is an obvious sign of aging.

3.  Grow thicker, longer eyelashes.  Our patients love their results with Latisse, a nightly drop of liquid that is applied to the upper eyelash base each night before sleep.  Within 6 weeks there is noticeable improvement in eyelash length and density.

4.  Fill in under eye hollows.  This has become a very popular treatment.  The only filler that we use in this delicate and unforgiving area is Restylane because other fillers are more likely to attract too much fluid causing swelling and edema.  Filling this area blends the under eye "bag" with the cheek in the area where the body has lost volume.  Though there is not a good treatment for under eye dark circles, this treatment decreases shadows in the area giving the illusion that the dark circles are improved.  This is a most advanced area for injection, you should seek out injecting physicians who are expert in the area.

5.  Refresh tired looking eyes.  Upper eyelid surgery or blepharoplasty techniques have evolved over the past 10 years.  Whereas we previously aggressively removed excess skin, muscle, and fat from the upper lid under general anesthesia, we now appreciate that volume preservation is essential in this area.  In many cases, we can limit our upper blepharoplasty to skin excision only under local anesthesia in the office, using electro-cautery heat to tighten the muscle and fat pad.

6.  Redefine the brows.  This can be done non-invasively with neuromodulators and/or with Ultherapy brow lift.  In those severe cases, Dr. Sunder is an expert endoscopic brow lift surgeon, a surgery performed through very small incisions behind the hairline.

7. Soften forehead lines.  See #1 above. Patients who prefer a more permanent fix may undergo endoscopic brow lifting with destruction of the muscles causing the wrinkles. Other new technologies are using either radio frequency heat or freezing to permanently damage the frontal branch of the facial nerve resulting in decreased movement of the muscles.  Surgery and destruction of the muscles and nerves may result in unpredictable unnatural appearance; we do not favor these treatments.

8.  Get rid of the vertical lines around the mouth.  By far the best treatment of these lines is fractionated laser.  It may take multiple laser treatments.  We often treat the upper and lower lips with a very small amount of neurotoxin.  For those patients who cannot afford the 5 day downtime of laser, we prefer to treat the upper and lower lip lines with Ultherapy followed three weeks later with the injection of the lines with superficial dilute Juvederm or Belotero.

9.  Lighten heavy facial folds.  Light and shadow define the age of a face.  Where there are smooth transitions between light highlights and shadowing, the face appears youthful. With aging, highlights and shadows are abrupt next to each other (see any face that looks aged.)  The use of facial fillers including Sculptra, Voluma, Juvederm, Radiesse, Restylane, and even fat can restore youth to the volume depleted face.  As with any treatment, the artistic vision of the injecting physician is most important in obtaining a natural excellent result.  With the improvement of "off the shelf" fillers we are performing less fat transfer procedures.  The main reason is the lack of predicability of fat injections versus the other fillers.

10.  Prevention of wrinkles.  The greatest advice that you may take away from this report is that other than avoiding sun damage to your skin, the best thing that you can do for your skin for the rest of your life is to build up to a daily Retinoid regimen.  Retinoids strengthen the skin and stimulate collagen production.  Wear sun block, and avoid smoking.

11.  Stop wrinkles from forming.  This may be the most difficult for the majority of us…cut out sugar.  Sugar causes the skin to become more susceptible to sun damage by decreasing the activity of naturally occurring antioxidants.  Looks like Dr. Persky is doomed to a lifetime of wrinkles!

12.  Get rid of a saggy neck.  Nora Ephron's book entitled, "I Hate My Neck" was not a best seller for nothing.  Nothing says aging more than a saggy neck.  Most patients with excessive loose skin and muscle of the neck are candidates for neck lifting (often combined through the same incision with lower face lifting.)  Dr. Sunder excels in natural surgical lifting of the neck and face with minimal scars, most are not noticeable within a few weeks after surgery.  Those patients with less severe sagging have benefitted by non-invasive Ultherapy neck lifting, now including an extended neck lift indication.  Ultherapy is particularly effective in those patients who have had previous face/neck lift surgery.  One of most popular skin creams is Nectifirm which topically helps tighten the skin of the neck.

13.  Tighten lax skin.  A facelift with or without adjunctive fat transfer is the most predictable procedure to tighten lax skin.  In those patients who prefer non-invasive methods, Ultherapy has been quite effective in our practice.  We use Venus Freeze, a radio frequency technology to tighten loose skin on the neck, as well as anywhere else on the body where skin is a little too crepe'.  See #12 above.

14.  Minimize loose skin.  The New Beauty article suggests Ultherapy, a micro-focused non-invasive ultrasound technology for this indication.  We have been using Ultherapy for the past 3 years, finding that our patients are getting consistent rejuvenating results.  It is a perfect treatment for those in their late 30's, 40's and 50's who are not yet ready for face/neck lift surgery.  Dr. Persky believes that many patients who maintain their Ultherapy over the years may not ever need surgery.  Those patients in their 60' and 70's who do not wish to have any surgery, but wish to see some rejuvenation of their face and neck are also excellent candidates for Ulthera.

15.  Firm the skin.  The article recommends the use of the radio-frequeny device Thermage.  Thermage has a less than 38% patient satisfaction rating on RealSelf.com, an aesthetic patient chat site.  We have not been impressed with Thermage results over the years in our patients who have demo'ed the treatment.  We do not offer Thermage.  We prefer Venus Freeze (RalSelf.com "worth it" rating of 85%) in our practice.

16.  Enhance lost definition of the face.  The "Liquid Lift" is a treatment that uses injectable fillers to increase strategic definition of the face.  Sculptra and the new filler Voluma are excellent for this.  Again make sure that you are very careful about choosing your injecting physician, one with the artistic vision of DaVinci's facial proportions rather than Picasso's to avoid that "cheeks and lips on a stick" appearance of "The Housewives of Beverly Hills"!

17.  Fill out thin lips. We use Juvederm, Restylane, and Belotero to restore volume to lips.  We use micro-canullas to inject resulting in much less bruising and discomfort.  Patients biggest fear is that their lips will look unnatural, therefore it is always best to be conservative when filling lips, we can always add more.

18. Plump up saggy cheeks. See #16 above.  Once again, Voluma, Radiesse, and Sculptra are great for adding volume to the cheeks.  This treatment restores natural curves of the cheek and helps to lift the nasolabial folds as well. 

19.  Remove jowls.  This can be accomplished with either a surgical facelift, or in moderate cases with a combination of Ultherapy and fillers.  Many times jowls can be camouflaged by using filler in front and behind them.

20.  Refresh your skin.  Fractional laser treatment (Fraxel restore, repair, and Dual) will improve the tone, texture, and color of the skin.  Dr. Persky participated on the the television show "10 Years Younger" where the public guessed the age of patients before and after treatments.  Our patient had a Fraxel repair laser and the audience analysis was that she looked 12 years younger.  Sun damaged skin with brown spots responds well to Fraxel Dual.  Crepe' skin and acne scarred skin responds to Fraxel repair.  For those patients who cannot afford downtime, Fraxel restore is a mild pick me up for tired skin.

We wish you a happy and healthy New Year.  We are most grateful to practice facial aesthetics in an era when there are so many safe and effective treatments to offer our patients.  If you have any questions about facial aesthetics, please feel free to contact us.  Be well!

Article by
Encino Facial Plastic Surgeon