New Wrinkles in Facelifts
Some topics in medicine are superficial by definition. None, perhaps, are as superficial as cosmetic surgery, or more specifically “aesthetic” facial procedures. Plastic surgeons do wonderful complex reconstructions for trauma and congenital deformities, yet it is the elective vanity procedures that hold such interest for so many of us.
When Christopher Lasch published his best seller “The Culture of Narcissism” in 1979, he could not possibly have known how prophetic his analysis would be. Reading it at the time, I was struck by how incisive his social commentary was, but I never dreamed it would also mark the way of the future.
What was then a burgeoning trend has become the universal norm. Everything, even television news, is now sold with beautiful, insipid models and pretty young faces. One’s physical appearance has become more important than ever, apparently burying the values of intelligence, humor, kindness, originality, honesty, and the like. Today, the look is everything.
On the other hand, life is short — why not be beautiful forever? The problem is that most folks don’t actually get away with it. Don’t you think people can tell if you’ve had a little work done?
The first facelift, or rhytidectomy, is reported to have been performed in 1901. At that time, surgeons simply pulled up the skin of the face at the ears. This procedure did not give good long-term results.
By the early 1970s, surgeons began learning to lift progressively deeper layers of muscle and tissue, producing better-lasting results. Now there is also a “thread lift,” where the tissue is lifted on a barbed thread passed up through the face, and a “lifestyle lift” where smaller sections of the face are lifted under local anesthetic only.
But the deep-layer facelift is still the gold standard. You can expect to get about 8 to 10 years out of a good facelift before you might need some additional work.
Further enhancing surgical facial work has been the use of silicone, collagen, Botox, hyaluronic acid, and polylactic acid injections for local smoothing of wrinkles and creases, and filling deficient areas. They are office procedures, not requiring general anesthesia.
“Many people are confused about what technique is used for which facial issue,” says Dr. Paul E. Kelly. He is a Diplomate of the American Board of Facial, Plastic, and Reconstructive Surgery, as well as an ear, nose, and throat surgeon, and he practices in Southampton. “Botox is used to soften skin muscles to reduce the appearance of fine lines and wrinkles that are created by those muscles. Fillers address volume deficiencies, and surgery addresses excess volume,” he told me.
Dr. Kelly does not use Botox as a muscle-paralyzing agent, only as a softening agent. He says his patients can still smile and frown naturally; they just have fewer lines in their face.
The newer fillers have come a long way from the early, lumpy days of silicone. The polylactic acid fillers, Sculptra and Radiesse (also known as the liquid facelift), not only give that round fullness back to the tissue, but also have regenerative qualities. When the product is gone from the body, your own tissues will have created additional natural fill on top of what you had before.
One fundamental problem is the lack of extensive research outcomes on the different techniques. How somebody looks is very subjective. As Dr. Kelly puts it, the criteria for success are “in the eye of the beholder.” But plastics researchers are working on better research criteria.
There is a new wrinkle in the story. The inexorable appeal of cosmetic facial work has met another powerful modern trend — the love of all things “natural.” We now have the “non-surgical” or “natural” facelifts, performed by alternative practitioners or aestheticians.
Here in East Hampton, an acupuncturist, Shellie Goldstein, provides a multi-modality “non-surgical facelift.” She does not compare her approaches to surgery or injections, as they are much gentler. “I definitely believe in aging gracefully,” she told me, “and acupuncture can help with the graceful part.”
The claims for facial acupuncture include stimulation of the production of structural skin proteins, collagen and elastin, stimulation of circulation, improved lymphatic drainage, and exercise of the muscles of the face. Unfortunately, solid research is lacking.
Shellie also uses microcurrent electrical stimulation to firm the facial muscles, and facial ultrasound to warm and clean the skin. There is also red light treatment at 640 nanometers wavelength that may enhance tissue regeneration.
Dr. Kelly is skeptical about the efficacy of these natural facelift techniques. Most people will look cleaner and fresher after this sort of facial work, but do they still look different five days later? He also questions whether muscle weakness is a factor in the look of facial aging, as opposed to changes in connective tissue and fat deposits.
Still, there are people who swear by these less invasive approaches and are quite satisfied with the results.
Healthy skin is also about good skin care. Plastics techniques alone are not enough. You have to take care of your skin, and that requires more than expensive cosmetics.
If you want to see how personal habits can affect the skin, take a look at a longtime smoker. Cigarette smoking is a surefire way to ruin your skin. A poor diet of processed food and excess fat can lead to poor skin quality. These are problems the surgeons cannot readily fix. As always, excellent basic health habits will preserve all the tissues of your body, including your skin.
There are risks to cosmetic work. Dr. Kelly tells me that a significant part of his practice is correcting botched facelifts and poorly done injections. From my own training as a pain specialist, I can tell you that there can be a wide variation of quality of physicians doing injections.
Many doctors do not know the anatomy very well and do not do a good job of explaining the options and the products, or what problems could occur, and how problems could be fixed. Dr. Kelly takes plenty of time to explain these things to his patients.
“If you look at the celebrities who have had too much work done, for too long, they give plastic surgery a bad name,” he told me. “In the right hands, these techniques really can enhance the overall picture of you.”
Still, if you are a bit overly focused on your physical appearance, you might want to think about how people see you as a complete person, not just your physical appearance. And I recommend Chris Lasch’s book as an enduring classic.
We all know older people who are beautiful because of their personalities and the sparkle in their eyes. So you might as well face it: There’s no short-cut to total beauty.
By James N. Dillard, M.D. September 24, 2009
Dr. James Dillard served as a clinical professor at Columbia University Medical Center and now practices pain, musculoskeletal, and integrative medicine in Wainscott and New York City. Questions can be directed to jdillard@ ehstar.com.
