Sun Damage? Un-Damage

As most of us know, the sun is the primary culprit of speeding up the aging process. Damaging UV rays create deeper lines around the eyes and mouth, an uneven complexion speckled with age spots and broken capillaries, and yes, that dreaded increased risk for skin cancer.

Granted, these days we're smarter: sunblock is part of the daily product regime, tanning is passe. But despite our best protection efforts, chances are at the end of the sunshine season, our skin could use a little help to combat the effects of the summer sun.

Meet the fractional erbium 2940 laser. Skin rejuvenation with this low energy laser improves fine lines and wrinkles, sun damage and mild skin laxity. (Got acne scars? It’ll improve the appearance of those too!).

The fractional technology available today offers several advantages over the traditional ablative technology of decades past. Because it creates limited damage to the skin, it's more comfortable, healing time is faster (which minimizes the chances of scarring, infection and long-term pigment changes), and downtime is limited to a few days as compared with 2 weeks for ablative laser resurfacing.

Here’s how it works: The fractional laser creates microscopic points of injury into the skin, leaving surrounding tissue intact. As part of the body’s natural healing process, new healthy tissue forms, boosting collagen in the skin and also creating a tightening effect. Once healing has taken place, skin texture improves and lines soften. Results are gradual and you can expect to see improvements over the 3 months following your treatment.

So as we bid adieu to summer, and turn our faces to post-summer skin damage repair, let's think fractional laser for facial rejuvenation.

Need a Lift? Needle vs Scalpel...

If your neck needs a lift, chances are so does your face. In fact, these two procedures are often performed simultaneously. Today, however, we've learned several things about the way the face ages and those insights have influenced the way we approach facial rejuvenation. Your face may need a lift, but it doesn't necessarily involve a scalpel.

We know today that facial aging is a 3-dimensional process: wrinkles and sun damage to the skin, loss of volume, and general drooping of tissue. Instead of pulling it all up and snipping it off in a traditional facelift procedure (can you say "wind-blown" look?), surgeons today are filling lines with soft tissue fillers (Restylane, Perlane, Juvederm) or fat, and picking up that excess skin by revolumizing the midface (cheeks). Often referred to as a liquid facelift, if the needle can effectively meet your goals, a surgical facelift not necessarily indicated.

But that isn't to say that the facelift is a thing of the past. If you haven't taken preventive measures along the way, have significant drooping skin, and the aging process has simply caught up with you, a surgical facelift may be needed to meet your rejuvenation goals.

At the end of the day, it's all about a customized approach to your face. If there's one thing we know for certain in the aesthetic industry (contrary to past approaches), one size does not fit all!

Facing Fat Facts

Whether it's your own fat, synthetic fillers, or both for your facial rejuvenation goals, the same adage applies: One size does not fit all

Despite the aesthetic industry’s evolving attitude toward fat as functional facial filler over the past several years—from cynical to skeptical to accepting—Dr. Few has been fat grafting for more than 12 years. Today, no doubt about it, fat is fabulous. (Who’d have predicted that?)

Fat, says Dr. Few, may be uniquely “green” (a great way to recycle that unwanted collection from the waistline, no doubt), and offer a nice, long-term facial result, but, he points out, it isn’t a filler that completely transcends the overall filler category. In other words, just as certain synthetic fillers are indicated for specific components of facial rejuvenation, (ie, hyaluronic acids are used to fill lines, plump lips, put the apple back in your cheek), fat too has it’s strengths. Unfortunately, that doesn’t include filling fine lines.

“Fat is only good for volume, not superficial wrinkles,” says Dr. Few, a fact he often points out to counter the misconception among his filler patients.

While fat is routinely used for cheeks, chin and jawline, if you’ve got fine lines to fill, those are best left to the HA fillers (Restylane, Juvéderm, Perlane). In Dr. Few's hands, it's Restylane. And if fat just isn't your thing (or if you simply don't have the tissue to spare—ahem, nice problem to have!), Dr. Few says you can opt for Restylane all the way.

Side by side, here's generally how fat and Restylane stack up (all that's left is to decide is, which one is right for you?):

Fat vs Restylane

	Procedure Time, min	Cost	Longevity
Fat	45	$4000	Indefinitely*
Restylane	15	$1500 (2 syringes)	up to 18 months

*75% patients won’t need another filler for several years; 25% patients will need another round of fat in 3 to 12 months.

True or False: A good plastic surgeon = scar-less surgery

False! (Unfortunately...)

The reality is, anytime an incision is made into the skin a scar will result. A scar by definition is the seam where the skin heals back together. It's the seam itself that can vary-from a hairline scar that is barely perceptible to one that is red, raised and hypertrophic or, at the most extreme, a keloid.

What a good plastic surgeon can do is to make it inconspicuous by putting it in a discrete place and minimizing the scar itself. But, take note, even a good surgeon is at the mercy of the healing process. The fact is, some patients are more susceptible to scarring. (This is often determined by your personal history of scarring: If you've never had any problems, chances are you'll continue on that same path, and vice versa.)

The good news is that new and innovative treatments are in development to manage less-than-ideal scars. In fact, Dr. Few will be giving a presentation at the annual meeting of the American Society of Plastic Surgeons in Denver this September on an injectable substance to limit scarring. Stay tuned for more on this hot topic!

Dark or light skin tones: which do you think is more sensitive to aging?

Last week we asked you on Facebook to answer the question, Dark or light skin tones: which do you think is more sensitive to aging? Your answers varied. Here's what Dr. Few has to say:

Lighter and darker skin have their advantages and disadvantages. Lighter skin tends to be more susceptible to aging because of it's greater susceptibility to sun-related damage. Lighter skin also tends to be thinner and less oily than it's darker counterparts, making it more susceptible to environmental forces such as cold, dry weather and smoking.

Darker skin has inherent SPF in it, helping to minimize the damaging effects of the sun. The disadvantage with darker skin is related to an increased risk of hyperpigmentation (darkening) and bad scars with trauma.

Lip Service

When it comes to the perfect pout, what do your lips say?

While we used to frequently encounter that so-called "trout pout" of the last decade, today there’s definitely a backlash against any enhancement that looks obvious and “overdone.”

“It’s about enhancing your natural lip contours,” says Dr. Few. “If you try to change the shape, you could have a very unnatural-looking result.”

But how do you know? Dr. Few offers up 5 lip tips that will wipe the pout off your lips and leave you all smiles:

1. The upper lip shouldn’t be larger than the lower lip.
   “Although Julia Roberts has a larger upper lip [and pulls it off!], it’s generally an unnatural proportion and will result in an unnatural looking lip,” says Dr. Few.
2. Enhance your natural lip definition.
   “Don’t just make your lips bigger. This is a common mistake that creates those unnaturally protruding ‘duck lips’.”
3. Don’t expect to erase all your lip and mouth ridges and folds.
   “If you inject too much filler, the skin will stretch and create what we call ‘sausage lips’.”
4. Maintain your filler. (Restylane lasts approximately 6 months.)
   “Regular maintenance of your lips will create a more natural look, so don’t wait until it disappears to get a refill.”
5. Avoid permanent fillers in the lips.
   “While the idea of a permanent filler is appealing, if you don’t like your result, you’ll have to have it surgically removed. As we like to say in the industry, permanent fillers, permanent problems.”

Rethinking Anti-Aging

Media love to jump all over the still young and beautiful who feel compelled to stop aging in its tracks before it even begins. (Hello, Botox Babies!) If you think about it, it’s the quintessential attempt to “anti-age.” Imagine: no lines, no wrinkles and, yes, no sign of life’s experience… pros and cons to be sure.

But is that what we’re really after, anti-aging? I’d venture to say, most of us wear the odd line proudly. My very own are indications to the world that I’m not a baby and have indeed earned the respect that goes with my age and experience. Of course, I don’t want ALL of them left unchecked. (Yes, I do like my Botox, thank-you-very-much!)

So in a recent conversation with plastic surgeon and industry leader Julius Few, MD, of The Few Institute in Chicago, Dr. Few told me that he doesn’t use the term “anti-aging” in his practice. Wow. (Right?) I was intrigued by his perspective and it made me stop and ponder how the industry has changed and is continuing to change.

Let’s start with the Botox Babies phenomenon of the past decade. Pretty obvious. We don’t want to let time slip by and become the 50-something-year-old woman who faces the hard choice of (a) major surgery to get the results she wants or (b) settling for less-than-significant results with less invasive procedures (fillers can’t always replace a facelift!).

But that doesn’t mean we need to start erasing all signs of aging before they begin to avoid the “big” surgical procedure. According to Dr. Few, it’s all about timing and customizing your cosmetic treatment protocol based on the way your particular face and skin age (we all have different aging traits). The idea is to begin an individualized, step-up approach to facial rejuvenation that combines less invasive procedures with selective surgical procedures—at the right time, over time.

The take home message? It’s all about gradual, subtle change that changes with your aging face, rather than trying to change your face.

So it isn’t about anti-aging, it’s about managing the aging process selectively and strategically, embracing elements of aging while maintaining a youthful quality to your skin and facial contours. It’s that age-old (pun intended) expression: Age with grace.