Ready for a little lift?

Jon A. Perlman, M.D., FACS

Diplomate, American Board of Plastic Surgery

Clinical Assoc. Professor of Plastic Surgery,  UCLA Division of Plastic Surgery

Plastic Surgeon for the ABC TV Show Extreme Makeover (www.perlmanmd.com)

Even here in the heart of Beverly Hills not every patient wants to undergo plastic surgery. I’m often asked by friends and patients in their 40s through 60s what I can offer them to provide a younger and rejuvenated appearance. Generally the answer relates to the degree of improvement desired by the individual, as well as my assessment of the severity and nature of the aging that’s present.

As soon as someone walks into my consultation office, I am assessing their appearance and forming an impression of how they look compared to their chronological age. The signs of aging I look for are excess skin and bags around the eyes, drooping of the cheeks, neck and brows, the presence of jowls and the existence of unflattering hollowing of the cheeks from volume loss of the face.  Together or separately, these can result in an undesired aged and tired appearance.

The use of filler injections to the face such as Juvederm and Restylane has skyrocketed for good reason in the last several years.  Without surgery I can soften folds and wrinkles, improve bony contours of the cheeks and jawline and provide my patients a more youthful appearance free of recovery. I often supplement the use of fillers with the addition of Botox injections to the upper face to weaken muscle-related wrinkling and furrowing (frown lines, forehead wrinkles and crow’s feet most commonly), and provide mild brow elevation.  Fillers generally last for 9 to 12 months but Botox usually wears off after 3-4 months and needs to be repeated.  Used together, I see good improvement from fillers and Botox but there is an ongoing need for repeated treatment at ongoing expense.  Generally the best results from these fillers are for patients between their 30’s and mid 50’s.

For the most part, Botox and fillers successfully provides temporary modest improvement but ultimately many patients age sufficiently to need an actual lift with muscle tightening to potentially achieve the hoped-for 10 to 15 year improvement in their appearance. One of the unique things I provide my facelift patients is a supplementary fat injection. This gives them the potential for long-term volume enhancement and textural improvements to their skin.

At what age should a “lift” be planned?  That’s a decision I make with my patient as we weigh the degree of improvement that is reasonably expected, and balance it with the patient’s own sense of need and motivation.  Contrary to the old “wives tale,” I have never seen evidence showing that it is better (or worse) to have a facelift at a younger age.   I advise my patients that the best age for a facelift is when they are motivated by a sense of desire for a rejuvenated and refreshed look, and they are willing to commit to an average 2-4 week healing and recovery period. I also assure them that with modern techniques, I can camouflage the incisions and create a natural and long lasting result.