At each stage of the aging process, plastic surgeons have the opportunity to address the primary concern of the patient. When the appropriate strategy is taken, not only is visible aging minimized in the short-term, but a foundation is laid that ensures a more graceful aging process. The best face lift surgeons understand that a customized approach toward every patient is essential for achieving the best results. Below are some common aesthetic concerns and treatment options for patients in different age ranges.
In the 30s and 40s
These are the first decades where the evidence of aging starts to become a concern. Wrinkles that are faint in the early 30s tend to deepen over the next several years to become more prominent by the 40s, especially when left untreated. The barely visible lines around the eyes become deeper “crow’s feet,” and some structural sagging throughout the upper and lower eyelids may also be visible. Existing frown lines deepen, and new horizontal forehead lines appear. Around the mouth, vertical lines grow more pronounced, and the nasolabial folds deepen.
- Typical Treatments: BOTOX® Cosmetic and dermal fillers can be excellent options in these decades, adjusting the level of correction as needed and targeting new areas such as the nasolabial folds as indicated. Eyelid surgery may be considered by the mid to late 40s for droopy lids or puffiness below the eyes. An all-over laser or other resurfacing treatment can help tighten and smooth the skin’s appearance. Throughout these years, the importance of proper skin care for maturing skin should be impressed upon the patient.
In the 50s
By the fifth decade, aging usually affects the structural layers of the face, including muscle and connective tissue. These underlying changes are reflected in the surface of the skin as well. For example, the cheeks lose definition due to the migration of buccal fat along with increased muscle laxity. Instead of just wrinkling, the forehead and brow now sag slightly, overshadowing the eyes. The jowls grow heavier as well, blurring definition along the jawline.
- Typical Treatments: Surgical intervention at this point may be necessary, particularly through the mid face and brow. Cheek enhancement can also improve signs of aging in the mid face. Liposuction through the jawline may improve the appearance of minor jowling, although this is contraindicated in patients with pronounced skin laxity in this area; a facelift should be considered instead. Nonsurgical rejuvenations may be continued, along with resurfacing treatments to address hyperpigmentation.
In the 60s
Patients in their 60s typically will have a noticeable reduction in skin elasticity and firmness. Existing lines are deep and unmistakable, while hollowness appears through the mid face and temples due to loss of volume. There may be some drooping in the tip of the nose and corners of the mouth, as well as more pronounced hooding through the eyes and brow. By this decade, aging has progressed down to the neck, resulting in loose folds.
- Typical Treatments: While injectable fillers are still helpful for re-volumizing hollowness and adding definition, surgery is more commonly indicated at this point. Laser resurfacing can be incorporated to reverse existing hyperpigmentation and sun damage while also promoting collagen production. Eyelid surgery restores an alert, refreshed appearance to the eye area, while a brow lift does the same for the forehead. Sagging skin and banding on the neck can be corrected through a neck lift; adding a lower face lift as well resolves further jowling and sagging through the lower face and upper neck.
Dr. Alexander received his Medical Degree from the University of Maryland School of Medicine, one of the country’s first medical schools, and then had five years of intensive general surgery training at the University of North Carolina in Chapel Hill, serving as chief resident in 1993-1994. There he was one of two residents honored “Outstanding Teacher” by the Whitehead Society.
After becoming Board Certified in General Surgery, Dr. Alexander attended the University of California San Francisco, one of the premiere Plastic Surgery programs in the United States. There he completed two additional years of residency training in Plastic Surgery. Dr. Alexander is double board certified in Surgery and Plastic Surgery and is a Fellow of the American College of Surgeons.
Dr. Alexander specializes in facial rejuvenation, and was the first surgeon in California to perform the QuickLift,™ a revolutionary surgical procedure that takes years off the face with less downtime than traditional facelifts. He is a specialist in chemical peels and laser surgery and was selected to author the chapter “Facial Resurfacing” in Plastic Surgery, the premiere textbook of the specialty. He also specializes in facial cancer reconstruction and endoscopic, minimally-invasive procedures, publishing his own original research about endoscopic plastic surgery. He lectures in medical forums and has presented his results at both national and international surgical meetings.
