| Surgery to reverse the signs of aging |

As the life span lengthens in modern times, most people feel vigorous and energetic long after appearance begins to deteriorate as a result of advancing years. Yet, the visible effects of aging play an important part in the welfare of many average men and women. Almost everyone knows of people whose employment opportunities have been limited or curtailed because they "look old", even though they might be more capable and competent than younger individuals. All are aware of the limitations the appearance of aging imposes in the social sphere. Finally, the emotional impact can be tremendous.

It is understandable, therefore, that many people today are consulting cosmetic surgeons for help in eliminating the signs of aging when they first appear or after they are well established.

Two approaches to correct the problem exist. It is possible to have a well thought out plan of treatment, first the feature that is most upsetting, followed by other corrections at various intervals according to indications and the patient's financial priorities. The second is to combine several procedures in one treatment. The initial financial burden is greater but the overall costs are less than if the procedures were done separately. The recovery time for multiple procedures in most cases is only minimally longer. The amount of post-operative bruising, swelling and discomfort is usually greater. The aesthetic impact achieved by multiple procedures, whenever well indicated, is more harmonious and significantly greater.

When is cosmetic surgery indicated for aging?

This is an often asked question. The best answer probably is: when slackness of the skin of the face and neck and bagginess of the eyes is not a temporary condition relieved by rest or which becomes increasingly difficult to improve by cosmetics.

The facial aging process

The changes associated with aging do not occur all at once - they happen in a slow or not easily apparent manner and involve several components of the face.

The skull actually becomes thinner and smaller, thereby causing the overlying tissues, particularly the area of the face, to be in excess. This phenomenon, along with simultaneous loss of skin elasticity, results in the deepening of the lines of expression in the forehead and at the sides of the mouth. Sagging of the outer part of the eyebrows, so that the eyes appear small and "crow feet" form, the development of pouches along the jawline, and, of course the well known "double chin" all become evident.

At the same time degenerative changes occur in the outer layer of the skin itself so that it seems to "look tired", but more important, some faces become etched with numerous fine wrinkles in addition to sagging. (Fig 15).

Figure 15-a (click image to enlarge)

Figure 15-b (click image to enlarge)

Figure 15-c (click image to enlarge)

Figure 15-d (click image to enlarge)

 

The muscles around the eyes often weaken so that fat herniates through them to produce the commonly seen 'bags' or pouches, giving a tired and aged appearance. Part of the fat of the face is absorbed and the remainder begins to hang down unevenly and loosely due to the effects of gravity. Finally, and some people are seldom aware of this, the tip of the nose drops causing it to appear larger and longer.

It can be seen, therefore, that each individual presents a different problem or set of problems, and consequently, the corrective procedures indicated vary with the case. For example, one person may require only elevation of sagging eyebrows or improvement in the eyelids; a very young individual may need only correction of an early double chin or a change in a 'tired and sad' facial expression by forehead and eyebrow correction. On the other hand, a partial or complete face and neck lift may be called for. Finally, when the skin is weatherbeaten in appearance, it cannot be improved enough unless a chemical peel or laser resurfacing is done. (Fig. 15e and f).

Figure 15-e (click image to enlarge)

Figure 15-f (click image to enlarge)

This patient's facial aging occurred sooner and faster than
expected. In order to restore her attractive appearance, correction
of the upper and lower face, including laser skin resurfacing, was required.

Things you should know about this type of surgery

Not everyone seeking this type of surgery is an acceptable candidate. I turn down people with serious uncontrolled disease, those who are too obese, those who I think have unrealistic expectations or improper motivation.

Such surgery turns back the clock but it does not stop it. No operation can permanently prevent aging; but the individual never appears as old as she or he might if the operation had not been done.

You must be willing to accept the temporary swelling and discoloration which occurs to a varying degree following such operations. Though usually visually disconcerting, it is seldom painful, and most people feel it is a negligible inconvenience to pay for the physical and psychological improvement they experience.

As following all surgery, there will be scars, but these will be hidden in the hair or placed in natural facial folds or lines so that they eventually become inconspicuous or virtually invisible; at any rate, they may be adequately camouflaged with cosmetics and hairstyling soon after the operation. No matter how meticulously the surgery is performed, the quality of the scar can never be fully anticipated as it varies with the metabolism of healing peculiar to each individual patient and different with each region of the body. The much feared scar, called keloid, is extremely rare on the face and unheard of on the eyelid. Should poor scarring occur, minor revision under local anaesthetic six to eight months later, is carried out in anticipation of improvement.