Decades of Face: The Eighties, The Reinforcement Decade

Doreen Wu (00:00):
Welcome to Park Avenue Plastic Surgery Class, a podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host, Doreen Wu, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is Decades of Face: The Eighties, The Reinforcement Decade. We're here at the final episode of our Decades of Face series, the end of the line, the eighties. You already know what I'm going to ask. Tell me about the title, Dr. Bass.

Dr. Lawrence Bass (00:37):
Sure, Doreen. The titles in all of these episodes try to frame the perspective about how you should approach care in this decade. In this case, the messaging is really about the eighties and beyond. This is a time to reinforce whatever work you've done previously with treatments and occasionally with a small surgery.

Doreen Wu (01:02):
And what's going on in this decade?

Dr. Lawrence Bass (01:04):
It's very different for different folks. Some people are very healthy and active, some are preoccupied with health issues. Some people are really not being very social or not very much at this point, and others are still very active in social.

Doreen Wu (01:22):
So what does this mean treatment wise?

Dr. Lawrence Bass (01:25):
It means you pick the amount and type of treatments based on how much you want and need.

Doreen Wu (01:32):
And is that all?

Dr. Lawrence Bass (01:33):
No, actually selection is also based on the foundation of renovation that you've built previously in earlier decades that will speak to which features are in good shape and which ones need some work.

Doreen Wu (01:50):
What does this entail? How can I figure out an appropriate treatment plan?

Dr. Lawrence Bass (01:54):
This, as we've said multiple times on the podcast, points out the importance of careful planning with a skillful and experienced plastic surgeon. If your plastic surgeon of past decades is still practicing, they know where you've been and can see where you're going. If that surgeon has retired, find an experienced surgeon who's looking at details and planning with you to fulfill your individual goals and needs. Someone who will rightsize a plan that will help you look your best, but be something medically safe and comfortable to do at this point in your life.

Doreen Wu (02:37):
Okay. I'm starting to get it. At this stage, a lot of aging has taken place and there is some variation to be expected based on genetics, lifestyle, overall health, and previous plastic surgery. Still, I feel like I need some idea of what kind of things to look for. What are typical options at this stage?

Dr. Lawrence Bass (02:57):
That's a great way to look at it. It think about the typical and easy to do options, consider somewhat more involved options if a feature is really pronounced, and we're going back to our big categories of treatment. So Botox and other neuromodulators are still helpful at this stage. They don't tend to correct quite as completely due to a greater degree of fixed wrinkling, but dynamic wrinkles still respond and at this stage, they may actually take a little longer to wake up and regenerate the muscular activity than they did when you were somewhat younger. So it's one of the few things that actually gets a little bit better as we age. The next big category would be fillers, and these are our mainstay of what we do at this point in time. You need to use more than previously, but volume loss is a prominent feature of aging at this stage, so doubling down on this approach of volume restoration pays big dividends for large volumes or more complete corrections. Some people choose fat grafting. Now this is a procedure, but it's a minor one with minimal recovery and minimal surgical stress.

(04:27):
Energy treatments are also a major player at this stage. Skin, which is our surface protection against the elements is definitely not its best at this stage and pretty universally shows significant signs of aging. So anything that globally improves skin quality will make us look markedly younger. And this is a very broad range of treatments from very light treatments to somewhat heavy treatments. It could be a small series of no recovery treatments like intense pulsed light up to major release or peels with a week of recovery, but still no surgery or incisions. Because of this whole range of options and even within an option, the ability to vary the intensity up and down the scale, we can kind dial in what you need based on what you've done previously and how prominent the feature is. So as an example, brown spots, which were also called age spots or sun spots, would slant treatments one way. If we're chasing predominantly rough texture, that will respond to a whole range of treatments, and if we're chasing deep wrinkles, we're either going to need a number of light treatments or one heavier recovery based treatment, but still no surgery.

Doreen Wu (06:08):
I noticed you haven't said a lot about skin laxity treatments. Why is that?

Dr. Lawrence Bass (06:13):
That's very observant. You're exactly right. This is not the main time point when we're chasing skin laxity as a feature. It's still worth talking about though there are people who are having a second or third facelift at this time, or more typically a neck lift because that's really the area that gives out. The face typically only needs volume and has reaccumulated only a little bit of laxity, but the neck usually shows some hanging skin and some muscle banding, and it typically is relapsed to the point where there's some more obvious need for correction. For those who previously had a facelift, a neck lift, the small amount of laxity may be a minor issue. It's not what's really showing what decade we're in at this stage of the game. It's relatively minor, so some people choose to focus on volume and skin surface at this point, as I've already mentioned, because those are the areas where more severe findings are typically present and the treatments are less invasive and have a minimum of risk. But for people who have put off having a surgical lift, they will on occasion choose to proceed at this point in their early to mid eighties. But for many folks, this is really more than what they're looking for at this stage of life. I think it makes a lot of sense to not be surgically lifting at this point, although again, there are certainly individual exceptions for people who are very healthy and active, and I've seen some excellent results in folks at this stage if they're properly selected and they're good candidates.

Doreen Wu (08:09):
I also noticed that you still haven't said anything about non-surgical laxity treatments. If I'm trying to avoid surgery, isn't this a good option for getting some degree of laxity improvement?

Dr. Lawrence Bass (08:20):
Actually, Doreen, the answer is no. Let's look at the biology of how these devices work. I mean, when a plastic surgeon does a surgical facelift, excess skin is mobilized and redrapes smoothly and the excess is trimmed away. Some people respond more completely, some less, but it's a major change in everyone because we're just mechanically removing that excess skin. Non-surgical laxity treatments simply don't work in this fashion. Whether the treatment is laser, ultrasound, radiofrequency, or some other form of energy, the mechanism of action is creating a controlled thermal effect in or below the skin or at both depths. And the body's response to this biological stimulus creates new collagen and collagen remodeling. So collagen removal and collagen replacement, the response to these treatments is wholly dependent on how effectively your body mounts a response to the stimulus of the treatment. Unfortunately, as we age, this response diminishes, which is partly why we show laxity in the first place, and at this point in your eighties, it can pretty reliably be counted on to belittle to none.

(09:51):
So those who need laxity change the most are least able to benefit from energy treatments for laxity. In simple terms, you can push your skin, but your skin has retired 10 or 20 years earlier and it isn't going to make a meaningful response. Your skin can heal and do some things that we want with various aesthetic treatments, but laxity changes are modest with energy treatments, even when people are in their forties or fifties at that stage, a modest response for the modest laxity that's likely to be present, that's a pretty good fit, but at the point where you're in your eighties, it's just not a useful approach anymore. Energy treatments for wrinkles typically don't show quite as good a response either as when they're done in an earlier decade, but the response is still robust enough that these treatments are quite useful. But laxity treatments not so much.

Doreen Wu (10:56):
What about biological treatments like PRP or stem cell responses to the stem cells contained in fat grafting?

Dr. Lawrence Bass (11:04):
That's a great question because you'd think that if you are actually giving some of the biological mediators back into the skin, that that would make up for some of the aging change. But this is a very complex process how all of these signaling agents, growth factors and other things talk to each other, and recent studies have shown that there's a decline in people in their sixties and beyond in the ability to make use of this kind of signaling and create a visible impact on skin appearance. So it doesn't mean that it's useless at this stage, but the response is blunted compared to doing kind of treatment in your forties or fifties.

Doreen Wu (11:57):
Okay. Dr. Bass, can you give our listeners some parting takeaways from this final decades of face episode?

Dr. Lawrence Bass (12:03):
Absolutely. So at this stage, some people have given up on chasing their appearance, but other people are still very active. So very variable what you're going to choose to do, but in general, we're trying to avoid surgery just because we want to keep it simple, not take any unnecessary risks, but there are individual exceptions where a small surgery or even a fair size surgery can be very useful. But overall, again, we're trying to support everything like the little boy with his finger in the dyke. We're just trying to hold things together with the simplest things we can get away with. So we want to keep the best appearance we can, but keep it simple. However, that doesn't always mean tiny amounts. So for example, with filler, it's non-surgical, it's no recovery, but you're not going to get away with a syringe of filler globally on the face, you're going to be doing bigger volumes. Surgery's only going to be for people who are totally healthy and the procedures should be limited, not extensive. Remember the sensible priorities always safety first, then looking totally natural, then the youngest look we can produce still, a lot of things can be done at this stage that are very meaningful, and a lot of the non-surgical treatments like fillers and basic skin laser treatments like IPL can make a drastic difference in how old you look.

Doreen Wu (13:47):
Thank you, Dr. Bass for sharing your insight and expertise with us. And thank you to our listeners for joining us today to finish out our Decades of Face series. Stay tuned, another series Central to the Cutting Edge Plastic Surgery. We'll be starting very soon. Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review, and share the show with your friends. Be sure to join us next time to avoid missing all the great content that's coming your way. If you want to contact us with comments or questions, we'd love to hear from you. Send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.