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Your Complete Guide to Facial Rejuvenation
By William Truswell, Neil A. Gordon, Jon Mendelsohn, David A.F. Ellis, Harrison C. Putman III, Jack Kusler Addicus Books, Inc.
Copyright © 2007 William Truswell, M.D.; Jon Mendelsohn, M.D.; Harrison C. Putman III, M.D.; David A. F. Ellis, M.D.; and Neil A. Gordon, M.D.
All rights reserved.
ISBN: 978-1-938803-97-0
CHAPTER 1
A Change of Face: How We Age
When you look into a mirror, do you like what you see? If you don't, give yourself an "instant facelift." Place your fingers beneath your jaw or at the hairline and give your face a gentle tug. For a moment, your younger self will peer back at you. Frown lines will be smoothed away, crow's-feet will have taken flight, and your cheeks will look higher and firmer.
What happens when you release your fingers? Do you see the effects of gravity — some sag in the skin, some wrinkles, or folds, a bit of a tired look? The corners of your mouth may have turned down, eliminating your former natural, youthful smile. The years may have etched lines on your face, making you look older than you actually feel.
Don't despair. Like thousands of individuals who have experienced the same feelings, you may be able to reclaim your younger beauty by seeking facial rejuvenation. Every year more than 100,000 people, 85 percent of them women, choose to have facelifts and other techniques to counter the effects of aging. If the instant facelift made you look and feel younger even momentarily, then you, too, may want to consider a facelift.
Signs of Facial Aging
Eyelids
The eyelids are often the first harbingers of aging. Extra skin in upper and lower lids and bagginess under the eyes may become noticeable. We start to notice wrinkles, crow's-feet, at the corners of the eyes. We will also see wrinkles starting to develop across the forehead and between the eyes.
The area just below the lower lid may become discolored, turning a light gray, green, or brown. In very fair-skinned people, the thinning skin's transparency reveals vascular and muscle tissue beneath. This coloration isn't fixed by surgery, but it can be disguised with cosmetics.
Cheeks and Midface
Some of the earliest signs of aging occur in the midface region when the malar fat pads — the pads of fat that cover our cheekbones — begin to slide downward. When we are young, these fat pads sit on the upper cheekbones, creating a fullness to the cheeks and the regions under the eyes. However, as these pads begin to sag with age, they produce a number of changes in the face. We notice a hollowing under the eyes and in the upper cheeks; the nasolabial folds deepen (these are the creases that run from each side of the nose to the corners of the mouth); and the corners of the mouth start to turn downward. These changes typically create a tired look.
Jawline
As we get older, the skin and soft tissue along the jawline sags, becoming loose and thin. Sooner or later we develop jowls, excess fat and skin below the jawline, which "washes" away the middle third of the jawline.
Neck
As we age, loose skin droops between the thin muscles, the platysma muscles, of the neck. These muscles also droop with the skin, often appearing as bands or chords of loose skin. These bands are masked by fat in individuals with heavy necks.
Surface Changes in Skin
The outermost layer of our skin, composed of dead cells, is called the stratum corneum. As we age, the composition of this layer of surface skin changes. In our teens and twenties, every time we wash, this outermost layer comes off, leaving a fresh new surface. However, around age thirty, the stratum corneum becomes "sticky" and those dead cells begin to adhere. Pores open wider and look larger; wrinkles and discolorations appear. The skin dries and becomes thinner. Facial skin loses its youthful, translucent depth and glow and takes on a flat, matted look.
Why Your Face Ages
There are extrinsic and intrinsic reasons why skin ages, and the distinction between them is important. The intrinsic causes relate to gravity and your genes, things that cannot be controlled. The extrinsic causes, which can be controlled, include such things as sun exposure, tobacco use, weight fluctuations, stress, chronic illness, exposure to harsh climates, alcohol consumption, and poor nutrition.
What You Can't Change
Genes
The rate at which our skin and soft tissue ages is affected by our genes. You've probably noticed some people seem to have fewer wrinkles and firmer-looking skin than other people their age. This may be partly due to their genetics. Sometimes an entire family will retain an unusually youthful appearance. In other cases, the "family face" might keep pace right along with the calendar.
Cell Breakdown
As we grow older, connective tissues in the dermis, a layer of tissues below the skin, begin to break down, and cells aren't able to repair themselves as quickly as they did when we were younger. The connections between our bone structure and the soft tissue loosen and cause the facial tissue to droop. The production of both collagen, the main protein of skin tissue, and elastin, a stretchable protein, diminishes. As collagen production diminishes, our skin begins to droop and wrinkle.
There are two types of wrinkles. Static wrinkles are visible when the face is at rest. Dynamic wrinkles are those we see only when the face moves, such as smile lines that aren't deeply carved. We also lose muscle volume and tone as we age, which contributes to sagging.
What You Can Change
Exposure to Sun
Excessive sun exposure is the number one cause of premature aging. Early wrinkling and "age spots," known as photoaging and solar lentigos, are signs that skin has not been adequately protected from the sun. You can't undo damage that occurred in your younger years, but you can start now to protect your skin from further damage by the regular use of sunscreen and other protection from the sun's UVA rays. These rays penetrate most deeply and are most closely associated with premature aging.
Every day, year-round, apply full-spectrum sunscreen (SPF 15 or higher), and avoid exposure during the midday hours when the sun's rays reach Earth most directly. For about ten minutes a day, however, do let sunlight reach unprotected skin, because sun on skin triggers the body's production of vitamin D, which is crucial for bone growth.
Remember that, in addition to the sun, harsh weather such as wind and cold can also age skin that is not well protected and regularly moisturized.
Smoking
Smoking is harmful to every organ in your body, including your skin — the body's largest organ. Smoking causes lung cancer, heart disease, and other ailments. It also decreases the flow of blood and oxygen to your entire body, including your facial skin, thus starving your skin of nutrients. For this reason, most smokers appear to age more rapidly than nonsmokers. Smoking also produces fine wrinkles in the upper lip.
Yo-Yo Diets
Repeatedly losing and gaining weight isn't just hard on you emotionally, but repeated stretching of the skin as your body changes from heavy to slim to heavy to slim contributes to facial sagging over time.
Stress
No one can prevent all stress — it is a part of life — but limiting it, learning to relax, and living at a saner pace can influence the rate of cell aging. The stresses of chronic, stress-induced illness will leave their mark on the skin's appearance, too, so it's important to choose and maintain a balanced lifestyle. Staying as healthy as possible helps your face look younger.
Alcohol Consumption
Excessive use of alcohol dehydrates and ravages the skin, leaving it pasty and sallow. When you abuse alcohol, you tend to be undernourished, making your skin and hair dry and causing cracked lips; alcohol abuse can also aggravate acne and can make your skin look puffy.
Poor Nutrition
A wholesome diet helps cells renew themselves. Plenty of antioxidant-rich fruits and vegetables, whole grains, lean proteins, and healthful monounsaturated fats such as olive oil nourish your skin along with the rest of your body. A diet heavy in sugar, saturated fat, and junk food will do just the opposite. A low-quality diet shows on your face and speeds its aging.
Dehydration
Your skin needs lots of water. Water plumps up cells and helps to flush toxins from the body. Drinking eight glasses of water a day will allow your cells to work more efficiently, and your skin will show it.
How Can Cosmetic Surgery Help?
Cosmetic surgery, such as a facelift, can reverse many of the signs of aging. The intent of any cosmetic surgery is not to achieve perfection, but rather improvement. The first step toward having a cosmetic surgery procedure is finding the right cosmetic surgeon.
CHAPTER 2
Choosing a Cosmetic Surgeon
You've made the decision. You want to rejuvenate your face. Now the question is, "How do I find the best surgeon to perform the procedure?" Perhaps you already know the right cosmetic surgeon for the job. If not, finding the right surgeon is an important decision that merits your time and effort. You want a skilled facial plastic surgeon who has a solid reputation. And equally important, you want a doctor you "click" with — one you trust and feel comfortable with.
You might meet with only one surgeon and choose him or her to perform your facelift. Or you might choose to meet with two or three and then determine which surgeon will be best for you. Either way, meeting face-to-face will help you decide.
Ways to Find a Cosmetic Surgeon
If you flip open the yellow pages or do an online search, you'll find a number of cosmetic surgeons. Across the nation, there are several thousand cosmetic surgeons; perhaps many of them practice in your area. How do you find the right one?
Word of Mouth
Even in today's world of high technology, one of the best ways to find a qualified surgeon is still through the old-fashioned word of mouth. When patients are satisfied with their experience and their results, they often become a doctor's best source of advertising. If you have friends or relatives who have had facial plastic surgery, ask them about their experience and who performed their surgery. Ask them to describe their relationship with the surgeon. What level of confidence did they have in their surgeon? Ask about the expectations they had going in, and whether those expectations were met.
Furthermore, ask about the staff and the office suite. Did all these factors add up to a pleasing experience? How did the physician relate to the patient? Is the surgeon someone in whom you could place your trust?
Referrals from Other Professionals
Your primary care physician or other physicians, such as your gynecologist or dermatologist, likely have patients who have had cosmetic surgery. Ask these doctors for a referral to a surgeon whom they know and respect. Local hospitals and your local county medical society may also be able to refer you to competent facial plastic surgeons.
Non-health professionals may also be a source for referrals. Hair dressers and spa facialists often have customers who have had cosmetic surgery procedures and who can recommend good facial plastic surgeons.
Online Searches
The Internet has made it easy to search for virtually any kind of information, including information about cosmetic surgeons. Some of the best Web sites to visit are those of the professional associations of cosmetic surgeons. Members in these societies are accepted by their peers and have to maintain continuing medical education in their specialty. Each of these organizations has an online "physician finder" function to help you find a qualified expert near you. These organizations include:
• American Academy of Facial Plastic and Reconstructive Surgery www.facemd.org
• American Society for Aesthetic Plastic Surgery www.surgery.org
• American Society of Plastic Surgeons www.plasticsurgery.org
You'll also find the Web sites of various cosmetic surgeons. Be sure to do your research and carefully check the credentials of any surgeon you find online.
Qualifications of a Cosmetic Surgeon
Certainly you want a surgeon who has the proper qualifications. But what qualifications should you look for? When searching for a surgeon for your facial rejuvenation procedure, you need to look for several things. The surgeon should be a licensed physician with adequate training, board certification, and sufficient experience performing facial rejuvenation procedures.
Training and Education
Becoming a facial plastic surgeon requires the completion of several years of formal education and training. Education requirements include graduating from a four-year college or university with a bachelor's degree and then graduating from a four-year accredited medical school with an M.D. degree. An accredited medical school is one that meets national standards set by a national authority for medical education programs. Doctors who wish to perform facial plastic surgery must then complete at least five years of additional hospital training called a residency. During a residency, the physician in training, known as a resident, works closely with senior-level surgeons to observe their work and gain hands-on experience in the operating room. Once the residency is completed, the doctor can go into practice as a facial plastic surgeon. Or, he or she may choose to apply for additional training in an accredited fellowship. A fellowship is a program in which the surgeon specializes in advanced techniques and patient care in facial plastic surgery.
Once all formal training in complete, facial plastic surgeons are required to take continuing education courses throughout their careers.
Licensure
In order to practice medicine, a facial plastic surgeon is required to be licensed by the state in which the surgeon's office is located. State licensing is mandatory, and licenses are usually granted only to medical school graduates who pass a comprehensive exam. Each state has slightly different requirements, so if a physician relocates, he or she needs to acquire a new state license. To verify that your facial plastic surgeon is licensed, you can check with your state's medical board. You can also check with the medical board to see if any complaints have been lodged or disciplinary actions taken against a surgeon. A list of state medical boards and links to their Web sites are available on the Federation of State Medical Boards Web site (www.fsmb.org/directory_smb.html).
Board Certification
If you've done your research, you've probably heard that it's important to select a "board-certified" facial plastic surgeon. But what does it mean to be board-certified, and why is it important? Board certification means that a facial plastic surgeon has completed an accredited residency program of at least five years and has passed written and oral exams given by either the American Board of Otolaryngology (head and neck surgery) or the American Board of Plastic Surgery. Once a doctor is certified by the board, he or she is called a diplomate. A physician whose certification is pending is called a candidate. You can verify board certification on the American Board of Medical Specialties (ABMS) Web site (www.abms.org).
A physician isn't required to be board-certified to practice cosmetic surgery. In fact, board certification is a completely voluntary process. However, for your safety and peace of mind, you should choose only a cosmetic surgeon who is board-certified. Board certification provides the assurance that your surgeon is adequately trained. Facial plastic surgeons are required to renew their certification every ten years. Be sure your surgeon's certification is up to date.
In addition to board certification, a surgeon can seek additional certification in facial plastic surgery. The American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) offers certification to surgeons who are already board-certified. To qualify for certification from the ABFPRS, a surgeon must complete a two-day comprehensive exam, must have been in practice for at least two years, must have completed at least 100 facial plastic surgeries, and must subscribe to a code of ethics. Choosing a surgeon who is certified by the ABFPRS offers you additional assurance that your surgeon is an experienced facial plastic surgeon. You can verify an American or a Canadian surgeon's certification by the ABFPRS at the organization's Web site (www.abfprs.org).
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Excerpted from Your Complete Guide to Facial Rejuvenation by William Truswell, Neil A. Gordon, Jon Mendelsohn, David A.F. Ellis, Harrison C. Putman III, Jack Kusler. Copyright © 2007 William Truswell, M.D.; Jon Mendelsohn, M.D.; Harrison C. Putman III, M.D.; David A. F. Ellis, M.D.; and Neil A. Gordon, M.D.. Excerpted by permission of Addicus Books, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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