FACIAL AGING: YOUR FIFTIES & SIXTIES | LOOKING YOUNGER LONGER

May 01 2012
Christie Brinkley, age 58

Christie Brinkley, age 58

Last month, we addressed the middle stages in our three-part series on Facial Aging, the changes your face undergoes during your Thirties and Forties. In this post, our last segment of the series, we’ll wrap up with the changes your face undergoes during your Fifties and Sixties, and what we can still accomplish non-surgically through a combination of injectables – the neuromodulators (Botox, Dysport), long-term fillers (Sculptra, Radiesse), and fat transfer from your own body.

Heather Locklear, age 50

Heather Locklear, age 50

 

The aging process is affected most by two things, one over which you have complete control, your exposure to the sun and the environment, and the other over which you have no control, your genetics.

Julia Louis-Dreyfus, age 51

Julia Louis-Dreyfus, age 51

 

Regardless of how the signs of aging appear, we’ve made tremendous strides in pushing back the clock.

Jane Seymour, age 61

Jane Seymour, age 61

 

Celebrities like former supermodel Christie Brinkley (58), actresses Heather Locklear (50), Julia Louis-Dreyfus (51), Jane Seymour (61), Meryl Streep (62), Helen Mirren (66), and the

Meryl Streep, age 62

Meryl Streep, age 62

band Blondie’s vocalist Debbie Harry (66), remind us that women in their Fifties and Sixties are still considered “bombshells.”

Helen Mirren, age 66

Helen Mirren, age 66

 

It is the grace at which women enter, and then reside, in their Fifties and Sixties which add to their glow and vibrancy as much as their cosmetic or surgical enhancements.

Debbie Harry, age 66

Debbie Harry, age 66

 

Much of what I discussed in the last installment holds equally true in these next two decades of a women’s life:

Hollows and sagging are caused by the loss of volume

Hollows and sagging are caused by the loss of volume

 

Although losing weight has many benefits for your overall health, it can also intensify the signs of aging.Studies show that women over the age of 40 appear younger if they have a heavier face; conversely, losing just 10 pounds once you are over the age of 40 can make you look at least four years older, and that gap grows as you age.

Deepening laugh lines, nasolabial folds, and marionette lines due to the loss of fat and definition near the cheeks

Deepening laugh lines, nasolabial folds, and marionette lines due to the loss of fat and definition near the cheeks

 

The loss of collagen and fat from the face as a woman ages, even if she does not diet and is simply due to menopause, will inevitably result in deepening laugh lines, nasolabial folds, and marionette lines due to the loss of fat and definition near the cheeks, as well as thinning lips.

 

With so much affected by volume loss, a combination of approaches tailored to your unique facial structure and aging effects is called for, since different approaches may be used based on the results you seek. Volume loss can be temporarily corrected with injectables (which can be used repeatedly, over time), while fat transfer offers a longer-lasting solution. Ultimately – and we’ll discuss this is great depth in our five-part surgical series beginning this fall — a facelift is the gold standard for this type of problem. As Catherine Deneuve famously said, “After 40 you can have your face or your body, but not both!”

Using fillers and neuromodulators in tandem can address crow's feet, forehead wrinkles, and soften the "angry" look many women complain about

Using fillers and neuromodulators in tandem can address crow's feet, forehead wrinkles, and soften the "angry" look many women complain about

 

At this stage of life, fillers are almost always used in tandem with the neuromodulators, which act by weakening the contraction of muscles in the face.  When injected around the eyes, crow’s feet are softened and smoothed out. When injected into the forehead, the accordion wrinkles soften and the vertical frown lines between the brows are addressed, eliminating the “angry” look many women complain about.

 

Hyaluronic acid gel fillers like Juvederm and Restylane are used in tandem with neuromodulators for thinning lips with lots of perioral lines (these are the fine vertical lines where your lipstick migrates). Together, they restore volume while stopping the movement that is causing the wrinkling. Unfortunately, menopause often greatly accelerates the thinning of the lips in some women, and Juvederm or Restylane is one of the best ways to replace lost volume and restore a more youthful contour to the mouth.

Fillers can lift a sagging eye area for a more refreshed appearance

Fillers can lift a sagging eye area for a more refreshed appearance

 

Restylane is also utilized to fill in the hollows under the eyes and bring back that youthful, reflective quality. For drooping upper eyelids/brows with eye hollows, fillers can help lift the tail of the eyebrow– all of which rejuvenate the entire eye area, giving it a refreshed appearance and eliminating the shadows and hollows that often make women in their Fifties and Sixties look exhausted and worn out, when that is not at all how they feel.

Eat a balanced diet, exercise regularly, keep sufficiently hydrated, and maintain a steady weight

Eat a balanced diet, exercise regularly, keep sufficiently hydrated, and maintain a steady weight

 

As always, I close with the advice that — in addition to a balanced diet, regular exercise, sufficient hydration, and maintaining a steady weight – it is imperative that you apply sunscreen daily. It is the most commonly available and inexpensive anti-aging treatment you can invest in. Sun exposure is the main cause of premature aging, and now that you are in your Fifties and Sixties and investing in treatments to slow and reverse the signs of aging, you will undo whatever progress you have made – and paid for – by not applying sunscreen daily. Use an SPF of at least 30, and if you cannot tolerate a chemical sunscreen, use a physical sunblock like titanium or zinc-oxide.

Jane Iredale Mineral Cosmetics

Jane Iredale Mineral Cosmetics

 

Mineral cosmetics – which now appear in every mass cosmetics line from the drugstore to the department store, from the health food stores to Sephora, and to dermatologists and plastic surgeon’s offices like mine (we carry the Jane Iredale brand) — contain physical sunscreen because the primary ingredient in most of them is titanium dioxide. If you hate the feeling of sunscreen on your face in addition to makeup in the Florida heat, find a tinted moisturizer with a good SPF. Just don’t rely on the SPF 8 or SPF 10 in an expensive traditional liquid or cream foundation to be enough sun protection.

 

Starting in next month in May, we begin a new three-part series: Sun Worship | Bronze Now, Pay Later. As always, I invite you to leave your comments, suggestions, or ideas for topics you’d like me to address in future blog posts on our Facebook page. Until then, be healthy and happy, and always feel beautiful – because you are.

 

John G. Westine, M.D.

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The Rise Of The 20-Something Cosmetic Surgery Patient

Apr 15 2012
Lindsay Lohan through the years...

Lindsay Lohan through the years...

Last month, an article on the website of the financial monthly Forbes – not generally the place for a frank discourse on plastic surgery — discussed in depth the actress Lindsay Lohan and the rise of the 20-something cosmetic surgery patient. It was written between her appearance on The Today Show and hosting Saturday Night Live, while she was working very hard to revive an acting career that had taken a backseat to her personal behavior, repeated legal problems, and what may now be her biggest claim to fame: her stunning transformation from a freckled, fresh-faced redhead to brittle platinum blonde who easily looked a decade older than her 25 years.

Ms. Lohan miscalculated the public’s willingness to forgive and forget; within a week of her critically panned performance on SNL, a video began making the rounds on the Internet that was shocking both in its mean-spiritedness and accuracy. Using a computer program, someone created “Lindsay Lohan’s Changing Face — 25 Years in 60 Seconds,” taking a compilation of still photographs of her face and morphing them into a continuous shot that brought home just how much Ms. Lohan has made adjustments to her appearance.

Although the Forbes article, by staff writer Jenna Goudreau, was accompanied by a photo gallery titled “The Many Faces of Lindsay Lohan,” the impact of the 60-second clip, according to the writer at The Huffington Post who penned the article about it, “left (the staff) at a loss for words…her baby photos are cute, followed by images from her ‘Parent Trap’ years, and then things get scary.”  HuffPo also reported that the same week Lohan was in New York for her appearances on Today and SNL, Blondie singer Debbie Harry, age 66, was mistaken for her.

Like many celebrities, Ms. Lohan always denies having anything done to her face. And like most publications, Forbes turned to experts to assess what work they are quite qualified to tell she’s had done. Both the board-certified plastic surgeon and board-certified facial plastic surgeon agree there was lip augmentation, facial fillers of some kind, perhaps Botox. They also agreed she looked “overdone,” with one saying outright, “It’s changed her facial identity.”

Forbes‘ Goudreau cites a recent New York magazine feature suggesting a 25-year-old who wants to appear the magic age of 19 can ring up $49,000 worth of cosmetic work. She also includes a 2010 survey of U.K. women that reveals that 24% of girls aged 16 to 21 would consider having “work done,” which lead Barbara Ellen to write in The Observer: “Time was when women would be sternly instructed to ‘start feeling old and ugly’ in their 40s. Then it was ‘start worrying in your 30s,’ then, somehow unbelievably, their 20s.”

Goudreau goes on to quote the following statistics:

  • According to the American Society for Aesthetic Plastic Surgery (ASPAS), people age 35 to 50 have the most cosmetic procedures of any age group (44%), but those ages 19 to 34 account for 20%—or one-fifth of all cosmetic procedures. Unsurprisingly, women are the majority of patients, with breast surgeries and rhinoplasties are the most common invasive surgeries.
  • In the 2011 survey by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), the most common non-invasive procedures for women under 35 were Botox injections (64%) and hyaluronic acid injections (55%), and more than a third of surgeons reported an increase in cosmetic surgery or injectables in patients under 25.

Matthew Schulman, M.D., the New York-based, board-certified plastic surgeon and assistant professor at the Mount Sinai School of Medicine who was one of the plastic surgeons assessing Ms. Lohan’s new looks, speculates that the under-25 patient may be responding to current beauty trends, which prize fuller cheeks and pouting lips.

In the last decade, across all ages, treatments like Botox increased 621% to 5.7 million last year, and soft tissue fillers increased 190% to 1.9 million, according to the American Society of Plastic Surgeons (ASPS). Dr. Schulman told Forbes it may also be that cosmetic surgery has lost its taboo nature, particularly in this climate of reality television shows and reality “celebrities” who may actually encourage it by appearing in plastic surgeon’s offices.

“We’re increasingly seeing people in their 20s embracing fillers,” agrees Darrick Antell, M.D., a plastic surgeon at Roosevelt Hospital in New York and assistant professor at Columbia University. He has one mother-and-daughter pair that began coming in together when the daughter was just 18 — and that was six years ago.

Dr. Antell says there’s no medical downside to Botox or fillers because they’re temporary and don’t cause any physical damage. Doctors also agree that these minimally invasive procedures are usually just an introduction into the larger cosmetic world. “It can be a gateway drug,” says Dr. Schulman. “In terms of the psychological aspect, once you get one thing, you naturally look to the next thing.”

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FACIAL AGING: YOUR THIRTIES & FORTIES | LOOKING YOUNGER IN MINUTES, STAYING YOUNGER FOR MONTHS OR YEARS

Mar 22 2012

Last month, we started our three-part series on Facial Aging, beginning with how your face begins to age in your Twenties. This month, I’m going to address the changes your face undergoes in your Thirties and Forties, and what we can do with, (1) a combination of minimally invasive injectables often referred to as a “soft lift” or “liquid lift,” (2) skincare and the important active ingredients you should pay attention to, and (3) a topic you’ll learn is one of my favorites to harp on, the use of sunscreen on a daily basis. In fact, I’d like you to start thinking of it not as sunscreen, but as “daytime moisturizer.”

Kate Hudson, Age 43 in September/Getty Images

Kate Hudson, Age 33 in September/Getty Images

The signs of aging are inevitable, no matter how well you take care of yourself. They are, however, treatable. We restore a youthful appearance by replacing what the aging process has taken away: fat and collagen. It is the loss of these underlying components, which provide structure and volume that cause lines and wrinkles to become more apparent in your Thirties and Forties.

Fat Loss: Losing facial fat makes your face appear concave and deflated. You end up with under-eye hollows because of the loss of the fat pads under the eyes. In addition, this fat loss causes the veins supplying blood to the ocular region to show through this very thin skin, creating dark shadows often mistaken for the dark circles attributed to lack of sleep or allergies. Loss of facial fat also leads to sunken cheeks and temples. Constant dieting contributes to the amount of fat in your face; weight loss at this age will show up in the face as skin descent.

Angelina Jolie, Age 37 In June/Getty Images

Angelina Jolie, Age 37 in June/Getty Images

The other side of this coin is excess facial fat from weight gain or muscle laxity. At this time in your life, the results in your face can be excess fat around your eyes, jaw, and chin, and you end up with under-eye bags, a soft jawline, a double chin, and what is often referred to as “turkey neck.” It becomes more important, not just for your overall health, but for the signs of facial aging, that you maintain a healthy, steady body weight.  The more you “yo-yo,” the more it will show in your face.

Collagen Loss:  The loss of collagen in the face means less elastic skin, which causes wrinkles, lines, and skin that has lost is tautness. When your skin is young and elastic, it has the necessary support to naturally wrap around the structure of your face. When collagen is depleted, you end up with crow’s feet, drooping brows, laugh lines, jowls, and thin lips.

Jennifer Lopez, Age 43 in September/Wireimage

Jennifer Lopez, Age 43 in September/Wireimage

Naturally, you want to know how these issues can be fixed in minutes! Let’s start with those fast and most dramatic results, which are gained through the use of injectables. In your Thirties and Forties, the best results are to be had with a combination of neuromodulators (Botox, Dysport) and fillers (Juvederm, Restylane, Radiesse, Perlane, and Sculptra Aesthetic).  These procedures address both the softening of wrinkles and the plumping up of lines. This is what’s referred to as a “Liquid Lift” or “Soft Lift.”

The neuromodulators act by weakening the contraction of muscles in the face.  When injected around the eyes, crow’s feet will be softened.  When injected into the forehead, the pleat-like wrinkles can be smoothed, or the frown line between the eyebrows can be treated.

Berenice Bejo, Age 47 in July/Getty Images

Berenice Bejo, Age 47 in July/Getty Images

Hyaluronic acid gel fillers like Restylane are used in tandem with neuromodulators for thinning lips with lots of lines around them to restore volume along with stopping the movement that is causing the wrinkling. The other two candidates for using fillers in the lips are those who need to add back lost volume and those who need to help balance their features.

Hyaluronic acid gel is also used to fill in the hollows under the eyes. For droopy brows with eye hollows, fillers like Juvederm and Radiesse can help lift the tail of the brow, while Restylane can help correct the shape of the eye. Cheek hollows can be re-contoured using semi-permanent fillers to add fullness and prompt new collagen production. Sculptra Aesthetic, while it requires multiple treatments, is a great choice for restoring long-lasting volume.

Nia24 Skincare contains niacin, peptides and other ingredients

Nia24 Skincare contains niacin, peptides and other ingredients to treat sun damage and hyperpigmentation

If you are hesitant to take the step of these mildly invasive, yet long-lasting treatments (though nowhere near as long-lasting as surgical options) there are skincare ingredients that will most definitely show results over time, provided you are diligent. Certain ingredients stimulate collagen production, like peptides, which are chains of amino acids designed to penetrate the skin and communicate to our cells how to perform particular functions (and have the added benefit of speeding healing after chemical peels or laser resurfacing); niacin and vitamin C in the form of L-ascorbic acid  help treat sun damage and hyperpigmentation, and growth factors preserve and repair damaged collagen, reduce inflammation, repair damaged skin cells, improve skin texture and tone, and encourage cell division.

Obagi Skincare Systems include a wide range of products including retinoids and other physician-grade ingredients

Obagi Skincare Systems include a wide range of products including retinoids and other physician-grade ingredients

Retinoids, like retinol (over the counter) and prescription-strength Retin-A (like Renova), are derived from vitamin A and speed cell turnover, diminish the signs of sun damage, and fight acne.

Vivite Skincare uses proprietary glycolic compounds to exfoliate, hydrate and protect

Vivite Skincare uses proprietary glycolic compounds to exfoliate, hydrate and protect

Alpha hydroxy acids (AHAs) such as glycolic acid and lactic acid are chemical exfoliants as long as they are at concentrations over 4% but less than 20% or you risk burning your skin (anything above 20% is professional-grade).

Beta hydroxy acids (BHAs), such as salicylic acid, are also chemical exfoliants with the added benefit of being anti-irritants, anti-microbial, and anti-inflammatory.  BHAs can improve skin thickness, barrier functions, and collagen production, and in concentrations of 0.5% to 2%, much like AHAs, can exfoliate the surface of skin. In addition, BHA has the ability to penetrate into the pores (AHAs do not), and thus can exfoliate inside the pore as well as on the surface of the skin, which makes it effective for reducing blemishes, including blackheads and whiteheads.

Flickr:pandasinfedoras

The picture says it all/Flickr:pandasinfedoras

Finally, in addition to a balanced diet, regular exercise, sufficient hydration, and maintaining a steady weight, it is imperative that you apply sunscreen daily. It is the most commonly available and inexpensive anti-aging treatment you can invest in. Sun exposure is the main cause of premature aging, and that includes tanning salons and sun lamps, no matter what you have been told. Use an SPF of at least 30, and if you cannot tolerate a chemical sunscreen, use a physical sunblock like titanium or zinc-oxide. Mineral cosmetics contain sunscreen because the primary ingredient in most of them is titanium dioxide. If you hate the feeling of sunscreen on your face in addition to makeup in the Florida heat, find a tinted moisturizer with an SPF. Just don’t rely on the SPF 8 or SPF 10 in your expensive foundation to be enough sun protection, even if you wear a tablespoon of the stuff on your face. It’s not enough.

Next month, I will wrap up the series with Facial Aging in Your Fifties & Sixties. In the meantime, please feel free to leave your comments, suggestions, or ideas for topics you’d like me to address in future blog posts on our Facebook page. Until then, be healthy and happy, and feel beautiful.

John G. Westine, M.D.

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FACIAL AGING: YOUR TWENTIES | TREATING THE FIRST SIGNS OF AGING

Feb 21 2012

This month, we’re starting a three-part series on Facial Aging, beginning with how your face begins to age in your Twenties, and how we treat the first signs of aging and take steps to prevent and inhibit future aging through a combination of proper skincare, nutrition, and preventive treatments.

Aging is a very unique process, dictated by factors over which you have no control (genetics and hormones) and those which you can influence by your behavior (sun exposure, diet, weight gain and loss, and other choices). You enter your Twenties, depending on behavior that started in your teens like tanning, smoking, and skincare, with plenty of the collagen, elastin, fat, and healthy cellular turnover that characterize youthful skin.

But depending on those same factors, plus your genetics and hormones, the process of cell turnover starts to slow a bit, and the most mobile and expressive skin on your face – around your mouth and eyes – tends to show the earliest signs of fine lines.

Regular tanning (whether outdoors or indoors), smoking, a diet that lacks the requisite supporting blocks for healthy skin (omega-3 fatty acids, green vegetables high in water content and sulphur, orange vegetables high in Vitamin A, red vegetables high in lycopene, antioxidant-rich foods), lack of exercise, poor sleeping habits, poor skincare habits (sleeping in your makeup, over- or under-cleansing, over-exfoliation, using harsh cleansers and acne medications that over-strip the skin and cause rebounding in oil production), and not using sunscreen daily will all contribute to premature aging of the skin.

As a board-certified facial plastic surgeon, the face and its overlying and underlying structures are my area of expertise. And I can tell you absolutely that what you do in your Twenties has a direct correlation to what I will see when you are in your later years. If you take the proper steps now, invasive procedures can be pushed back by years and even by decades. Starting today, you can begin to treat the first signs of aging by…

  • Consulting with your doctor or a nutritionist about your diet, and having simple blood tests done to let you know where your diet is deficient. This is important for your skin, and for your overall health.
  • Keeping hydrated. Your skin and your body require water to help eliminate toxins and waste. There is no substitute for water – not diet soda, not sports drinks, not even fruit juice. Water is alkaline, which is your body’s optimal internal environment. Sugar creates an acidic environment; overexposure to sugar increases glycation and speeds up the aging process. And one of the biggest sources of sugar in the American diet, after soda, is metabolized alcohol.
  • Beginning to use a high-quality skincare regimen that treats your skin type and skin issues. Do not believe marketing hype; the cosmetics and skincare industry is one of the most consistently misleading marketers, is one of the biggest advertising spenders, and is constantly looking for ways to wiggle around FDA rules in its marketing claims. Self-diagnosis of your skincare needs can be tricky; most people tend to overuse active ingredients and cause irritation, thinking “if some is good then more is better.” Constant irritation will cause aging. It can also exacerbate rather than clear up acne. A plastic surgeon, dermatologist, or licensed aesthetician is educated in both skincare issues, and the treatments that work best. It’s worth the time and investment; even drugstore skincare adds up if you keep buying the wrong products and throwing them away, or worse, creating new problems that require more products, and so on. In our practice, we use the Obagi skincare line, NIA24, and Vivite. There are other high-quality physician/aesthetician-available skincare lines, and you  will find that the price points for most lie in between those at the drugstore (Olay is no longer the bargain brand it once was) and the department store. The difference is that these lines contain much higher levels of active ingredients and the proper pH for maximum efficiency and results, fewer extraneous ingredients, are often fragrance- and irritant-free, and are packaged to preserve ingredients that often degrade or oxidize on contact with the air or the bacteria on your hands.
  • Wearing sunscreen every day. Sunscreen is the best anti-aging product you can buy. All other anti-aging products treat the problem after it appears. Sunscreen, used regularly, prevents the problem. Think of sunscreen as your daytime moisturizer. There are so many on the market now, for every skin type, as well as tinted sunscreens, mineral makeup with natural sunscreen (we use Jane Iredale in our practice), and both chemical and physical sunscreens that there is a product that will suit your skin. Again, this is where consulting with a plastic surgeon, dermatologist, or licensed aesthetician can help you make the choice that is best for your particular skin type.
  • Considering preventive injectibles. By softening certain repetitive facial movements that cause lines and furrows now, Botox and Dysport (and later this year, Xeomin) eliminate existing wrinkles and prevent new ones from forming. In particular, the area between the eyebrows (called the glabellar region) can already show fairly deep furrowing in people who frown or squint excessively. If the muscles that allow you to make those expressions are immobilized, the skin flattens out and the wrinkle disappears.
  • Injectible fillers can be used to make subtle modifications to the face as well, like add volume to a slightly receding chin or lift the tip of a drooping nose for a more proportionate and youthful profile, or balance out uneven lips. A board-certified facial plastic surgeon is the best person to consult if you are unhappy with certain aspects of your face, as he or she is going to recommend the most conservative and least-invasive treatment whenever possible, and has the best education and understanding of the structures of the face.

Next month, I will address Facial Aging in your Thirties and Forties. In the meantime, please feel free to leave your comments, suggestions, or ideas for topics you’d like me to address in future blog posts. Until then, be healthy and happy, and feel beautiful. John G. Westine, M.D.

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Hello, beautiful!

Jan 19 2011

Welcome to Dr. John Westine’s blog, The Art and Business of Creating Beauty. We’re happy to have you! In the coming months, Dr. Westine will comment on a wide range of topics, with one thing in common: how the marketing of beauty and the science of cosmetic surgery, scientific developments in skincare, inventions and patents in ingredients, and the tremendous dollars that go into both affect the decisions you ultimately make about what you do with your skin.

This blog will be educational, informative, give you an “insider’s” perspective, help you understand the difference between measurable results and marketing hype, between real scientific product testing and tests performed by the makers of a product on 12 women for 24 weeks (guess which you want to put you money behind?), understand ingredient labels, marketing claims that sound an awful lot like medical results, why there isn’t a cream on the market (yet) that can ever replace Botox, and why saving the money you spend on two jars of $500 French skin cream could buy you a wrinkle-free forehead or eliminate your crow’s feet that the cream will never, ever duplicate. We’ll talk about the best cosmetics for post-surgical and post-laser skin, how heredity affects the outcome of laser treatments, why your diet may be aging your face, why the best anti-aging facial cream on the planet is called “sunscreen,” and so much more.

The best part of having this blog is that you can ask questions, and get answers. You can comment on what we say, ask for clarification, find out where to get more information, and get to know a plastic surgeon who loves what he does, who is conservative in his methods, and who truly cares about changing lives for the better. Yes, we create beauty on the surface through “artificial”means, but we also believe that we are most skilled at revealing the beauty that lies within our patients, in bringing what’s inside out for the world to see.

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