In our current healthy and image conscious environment many people choose to maintain fitness by running, jogging, or high impact aerobics. While these exercises are great for cardiovascular fitness they are extremely bad for facial aging. First and foremost facial aging is primarily a result of loss of skin elastic tissue due to sun damage, environmental factors and smoking. Pounding the pavement has an adverse effect on facial aging in the face of poor skin elasticity. Compression garments can be worn to hold firm abdominal, thigh, and buttock tissues as protection against the effects of running on these tissues. No such garment can protect the face from the deleterious effects of extreme exercise. Runners are usually thinner than others of the same age. It is a well-known fact that while healthy, thin faces age quicker than faces with some fat content. The opposite is true for necks – little fat in the neck is good whereas a fat neck is difficult to contour. Many people who exercise heavily do not maintain adequate hydration. Drinking large amounts of water help keeps skin hydrated and less likely to manifest dryness, fine wrinkles, and laxity of aging. There are plenty of aerobic exercises and machines that provide a serious workout without the up and down pounding that can exacerbate the facial aging process.
There is a certain subset of patients who, by genetics or trauma, will require a true septo-rhinoplasty to correct breathing problems and to straighten an injured nasal pyramid. There is a much larger group of patients who have relatively minor cosmetic nasal problems, usually confined to the tip or the bridge of the nose. It is a well-known that the tip of the nose tends to lose its support as we age causing the nose to tilt over the upper lip and gives the impression of a longer nose. Minor nasal tip cartilage problems can create the impression of a “boxy” tip or even a “pointy” nose. Minor bridge problems can be addressed with small operations.
The use of filler in the nose has only recently become popular. There are a few situations where fillers may improve the nose without surgery. Small discrepancies of the nasal bones usually due to trauma and certain small tip and bridge asymmetries may be improved with the judicious use of fillers. To this point in time the “perfect filler” is still your own fat. Harvested and processed fat is long-lasting and usually does not require secondary procedures.
The nasal refining procedures do not require general anesthesia and are not covered by insurance. These procedures are for refining the nose and as such do not change to overall ethnicity of your nose. Think of your same nose yet more refined, elegant, and at a greatly reduced price. For some people a major nasal reconstruction may be necessary due to trauma, for those who want a completely new nose, or those with significant nasal breathing problems.
Dr. Paul Howard
Men pay for approximately 80% of the cosmetic surgery performed while becoming a patient only 20% of the time. It is hard to know if this is indicative of the social taboo regarding men and cosmetic surgery or is it a result of the idea that men are much less stoic than women and are basically averse to the minimal discomfort involved. Regardless of the cause, men are more frequently having plastic surgery and generally have the same reasons for having cosmetic improvement as our women patients: improved self esteem, being competitive with younger people in the work place, and to appear more youthful and attractive to the opposite sex.
Men age somewhat differently than women and require surgeries that are tailored for their specific facial aging issues. For instance, men are more likely to complain about their necks while women focus on the midface/cheek area. Both men and women have upper and lower blepharoplasty but men rarely want the browlift procedure so as to not look like “Kenny Rogers.” Kenny Rogers is a well known celebrity, singer, actor and country music star who was the unfortunate victim of an overdone browlift – forehead too tight, too smooth, too high, thus totally changing his appearance for the worse. In addition to eyelid and neck rejuvenation men are likely to inquire about liposuction of the waist and abdomen area. Men desire a nice tight, jaw line and neck with a youthful profile, a sculpted waist and bright, open, uncluttered, youthful eyes. Post-operatively, men tend to go back to work too quickly, tend to bruise worse than women, and are less likely to follow post-operative instructions. Men and women both require a full dose of positive reinforcement throughout the healing process. Early and often post-operative photos to document healing and cosmetic improvement are helpful during the early stages of healing where bruising and some swelling is to be anticipated. Men are less likely to keep all of their post-operative appointments and tend to be more secretive regarding their surgery than women. Men are uniformly less patient while healing but more appreciative of the good results and more youthful appearance over time. Men are less likely to have researched the procedures they want and tend to be referred mostly by other patients and thus are less affected by marketing schemes than women. Terminology is also important to men who shy away from the term “facelift” but respond well to being offered a “necklift.” Even with their idiosyncrasies, men are generally some of our most appreciative patients.
Dr. Paul Howard
Botox and Restylane have become the mantra for those seeking facial rejuvenation without the inconvenience of having a “surgical procedure.” While these off-the-shelf products are enticing, they are expensive, temporary, and can be painful to inject, especially in the lips. For more Plastic Surgeons, these artificial fillers (Restylane, Juvederm, Strattice) are appropriate only for temporary improvements where there are time constraints and the need to be in public within a couple of days. Searching for the perfect facial filler had been elusive until recently. The emergence of fat from your own body (autogenous) has paralleled the refinements in fat harvesting and injection techniques that have elevated the “take” of fat injections to the 80-90% range. Coupled with improvements in local anesthesia and anesthetic agents make the overall experience with the new fat injection techniques less painful and more likely to give a permanent, elegant improvement in facial contours and rhytids (wrinkles). Many non-surgical practitioners complain of the donor site for obtaining the fat. While we must respect the donor site, offering the patient an improvement in body contour by harvesting fat for injection offers the patient the benefits of a liposuction (method of harvesting fat) procedure and cosmetic improvement of the donor site as well as the areas of the face injected with fat.
What does the future hold for facial fillers? Ongoing research using stem cell and growth factor technology may lead to even further improvements in fat injection techniques while artificial filler research tries to make their artificial substances last longer and the cost with longer lasting substances is naturally higher and will continue to increase over time.
Fat injection techniques have proven to be a vast improvement over foreign-body injections for facial rejuvenation. Fat is permanent, soft, cannot be rejected by the body, natural, and requires only small (3-4mm) stab wounds for injection. The patient can request which body area is preferred as a liposuction donor site obtaining body contour improvement at no additional charge. The well informed patient will usually choose the elegance of fat injection over the expediency of foreign material injected in the face.
As an extension of fat technology, we have begun fat injections in the back of hands for hand rejuvenation. The injected fat decreases the appearance of prominent veins, knuckles, and tendons that become more pronounced as we age. No one should let their hand reveal their age when we have the procedures to reduce the signs of the aging hand.