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Wayne P. Foster, MD, FACS, is the area’s leading facial plastic surgeon.
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The Aging Face

As lifespans lengthen in modern America, most people feel vigorous and energetic long after their appearance begins to deteriorate and show the signs of aging. It is no wonder, therefore, that the number of people consulting a facial plastic surgeon has grown tremendously in recent years.

Looking older than one feels can have a tremendous impact on one’s psychological, social and even economic well-being. Almost everyone knows someone whose ascent up the corporate ladder was stunted because they looked “old and worn out,” in spite of the individual being more capable and accomplished than younger individuals.

Today, many people are consulting facial plastic surgeons to eliminate the obvious signs of aging either as these signs first appear, or long after their development. Those who “nip the aging process in the bud” are continuing with a maintenance program of minor surgical procedures. These people never seem to age or grow older in comparison to their contemporaries. This is the ideal situation for many people and the approach many celebrities have chosen to follow.

Aging Process of the Eyes, Face and Neck

The signs of aging first appear in the mid-to-late twenties and steadily progress thereafter. The eyes classically show the first signs of aging. The supportive underlying tissue weakens and allows fat to herniate through the tissue producing the commonly seen, visible bags and swelling resulting in the “tired look.” Crow’s feet deepen, excess upper eyelid skin develops and fine wrinkling of the skin worsens.

The foundation of these changes resides in the skin, fat, muscle and bones. With age, the skull thins and becomes smaller, allowing the overlying tissue to shift downward. This process, along with the loss of the skin’s elastic tissue, produces deeper and more noticeable lines on the face as well as sags and bags. Deepening lines on the forehead and corners of the mouth with sagging of the jowls and outer eyebrow are all part of the normal aging process.

The outer skin slowly degenerates, etching fine, medium, and deep wrinkles into the lips, eyes and face – especially in women. The ears sag as the earlobes elongate. Ultimately, the tip of the nose droops, producing a longer-appearing, sagging nose. In this case, the nose lift is very effective at restoring a naturally youthful appearance.

These generalizations of aging affect each individual, but each person represents a unique problem. Consequently, the procedures necessary to correct the signs of aging may vary from person to person. The rate of aging is affected by heredity, stress, smoking and sun exposure. Excessive sun exposure accelerates the skin changes and the aging process.

One person may require a chemical peel and laser resurfacing while another may need a facelift and eyelid surgery or a nose lift. Each patient is assessed and treated individually with a customized treatment plan.

When Should I Consider a Change?

During a typical consultation, patients frequently ask when they would benefit from a cosmetic procedure to reverse the signs of aging. The most universal “physical” answer is when skin slacks and “bags” around the eyes are not temporary and relieved by rest. Exactly when these signs of aging become noticeable varies from person to person, again depending on one’s heredity, and behavioral and environmental factors such as smoking, sunlight exposure, diet, stress, etc.

Also, a person’s age offers no particular restriction for people considering facial plastic surgery to remove the signs of aging. Patients in their thirties may benefit from certain procedures while others in their seventies or even eighties may be good candidates for surgery, provided they are in good mental and physical condition.

Aging plays an important role in each individual’s personal, social, and emotional well-being. Just as everyone ages at a different pace, everyone also has a differing tolerance for showing the signs of aging. As mentioned before, as human lifespans lengthen in the civilized world, many people feel vigorous and healthy long after their appearance begins to deteriorate. Increasingly, people are considering the option of a facelift as a way to “look” as young as they “feel.” In addition to its physical improvement, a facelift can provide significant emotional and self-image benefits.

How Long Will My Results Last?

The lasting effects of a facelift are naturally an important concern for those considering the procedure. The effects of surgery last forever while the aging process continues. There is also a rebound relaxation of the facial tissues that causes a minor degree of tissue relaxation. No operation can permanently prevent aging, but the person who elects surgery never appears as old as he or she would without the surgery.

Surgery moves the patient back several years on the conveyor belt of time and aging. The conveyor belt perpetuates, but the patient’s appearance moves back several years and continues to age from that new point. Although not necessary, some individuals elect to undergo subsequent smaller surgeries to maintain this more youthful look.

Am I A Good Candidate for Facial Surgery?

Some patients seeking facial plastic surgery are not acceptable candidates. Certainly, any individual whose function or appearance is not improvable is not a candidate for this procedure. Surgery is not recommended for those with serious medical conditions or severe obesity. If a patient is in the midst of an emotional crisis, they should postpone surgical considerations until their situation stabilizes. The patient with unrealistic expectations or inappropriate motivations will be refused surgery.

Clearly, the patient must understand that all surgery incisions will heal with a scar. These are usually hidden in the hairline or placed in the natural facial folds to become less visible with time. Makeup and hairstyling are critical in camouflaging the scar as it matures. Of course, each patient heals at a different rate and with different types of scar tissue.

Swelling is expected immediately following surgery, and in fact, usually worsens for two or three days before it begins to resolve.

Discoloration is minimized with the techniques employed, however, after the surgery, temporary bruising may occur. These are minor inconveniences compared to the physical and psychological benefits the patient ultimately will experience.


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