It’s complicated. I consider multiple areas of aging that occur in face: Loss of volume, skin quality, changes in elasticity, pigments problems, overactivity of the muscles that leave wrinkles when you move your face, and looseness of the skin (hanging skin in the neck, drooping of the cheeks and eyebrows). All areas need to be addressed in different ways to get the best result. To turn back the clock, loose skin needs to be lifted surgically to remove excess skin and to reposition the skin as well as it’s deeper layers. We have to also look at skin quality—crepiness, pigmentation, does it look soft or watery. If you have a tight face with old skin, it will not look rejuvenated. The patient may need good skin care, topical treatments and laser resurfacing. If we do just a lift so the skin is tight, but there is no softness from loss of volume, than the patient looks pulled and sometimes skeletal, so we have to add volume. In the old days, we just did lifting, which made patients look pulled. The skin looked like it was stretched over bone because we didn’t have any other options. Today, we can give patients a natural and soft appearance which is what youth looks like. Adding volume gives us that more youthful look. We can add volume to lips and cheeks; we can fix the skin with laser resurfacing and we can treat overactive muscles that distort the skin with Botox, Xeomin, and Dysport—which can be helpful in stablizing and preserving a browlift. You have to protect your investment and keep your results. You have to start early to preserve your skin.
Q: What is the best way to rejuvenate the face? Surgically? Non-surgically?
What our experts say:
There is no best way. It depends on what the problem is – skin aging, loss of volume, drooping tissue, etc.