Chicagoland plastic surgeon Michael A. Epstein, MD of MAE Plastic Surgery and Concierge Aesthetics & Plastic Surgery says that when making recommendations after a consultation, the most important considerations are treating the patient’s concerns as well as their actual physical signs of aging. “If you break down how a face and neck typically age, it’s usually a combination of three components,” he explains. “It’s about the quality of the skin, how much volume is in the face, and what happens to the face and neck as it relates to gravity. I call this the trinity of the aging face.”
While sun damage, smoking, and poor attention to skin care play a major role in how facial aging occurs, genetics is probably the most important factor explains Dr. Epstein. “In other words, looking back at how your parents aged will generally give you an idea of what is coming,” he explains. Dr. Epstein says that typically these include changes in the skin quality, volume depletion, and or sagging. “I explain to each of my patients that to get a long lasting and most natural result it is important to treat the factors and parts that are causing the aged appearance, not more and not less,” he says. “The good news is that a combination of procedures can be done safely and work better in tandem.”
It is not uncommon for him to perform, for example, a blepharoplasty, a facelift, structural fat grafting, and a full face chemical peel to address the multiple signs of facial and neck aging to achieve the best rejuvenated appearance. “I believe resurfacing, or the chemical peel, helps enhance the surgical lifting results. If I just lift skin that is no longer elastic, the result is going to be inferior,” he says. “You will get a more natural-looking result if you combine these procedures when it’s necessary.”
Blepharoplasty, or eyelid surgery, can remove excess skin and fat from the upper and lower eyelids. “When you’re talking about upper eyelid rejuvenation, you must consider the adjacent structure above it to make the right diagnosis and assign the most correct treatment,” explains Dr. Epstein. “The forehead may be sagging and pushing down on the upper lids which in turn can create the appearance of excess skin.” Excess eyelid skin may or may not be the problem at all. If the forehead is the real problem then a forehead lift, also known as a brow lift, would be the treatment of choice.
In a similar way, when evaluating lower lids, the upper cheek should not be ignored. “Many times the bulging fat bags of the lower lids may look worse because the upper cheek is so hollow or has descended downward,” he says. Fat bags may or may not be associated with either redundant or crepey, wrinkled skin and that may need to be addressed as well.
Lifting Sagging Skin + Soft Tissue
A facelift’s primary function is to treat sagging skin and soft tissue of the face and neck while smoothing out wrinkles and fine lines. “The three most common types of facelifts that I do are a modified deep-plane facelift, where I’m going below the SMAS, or submuscular aponeurotic system; a minimal access mid- lower facelift and necklift; and a skin only subcutaneous lift for younger patients with minimal sagging. Once again, these lifts often need to be complimented with skin resurfacing and or structural fat grafting to replenish soft tissue volume that has withered away.”
Improving Tone + Texture
To reduce the appearance of wrinkles, sun damage, age spots and to retexturize skin, Dr. Epstein prefers a TCA chemical peel, especially when combining procedures. “I like the TCA peel because there is less down time, less risk, and most of the time the patient doesn’t need something more aggressive. t’s certainly more aggressive than what my estheticians are doing in the medical spa, but not as aggressive as some of the fractionated lasers or radio-frequency that I use when the wrinkles and skin damage is worse.”
Together, these solutions can help achieve a more comprehensive and natural rejuvenation of the face, addressing multiple signs of aging to look younger for longer. “By combining the right procedures, you can often achieve more dramatic results that look more uniform and last longer than with one procedure that may not address all signs of facial aging,” he says. Dr. Epstein also urges patients to remember that there are other less invasive, nonsurgical methods to treat the trinity of an aging face especially early on in the aging process. “Concierge has Medical Spas in five different locations that offer the most up to date treatment methods that will help slow down this aging process and enhance your surgical results if that is what is initially indicated.”