Decades of Face: The Forties, The Support Decade

PA_51 Decade Forties.txt
Doreen Wu (00:01):
Welcome to another episode of Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your cohost, Doreen Wu. 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: Forties, The Support Decade. Dr. Bass, we are progressing along in our series Decades of Face. We're up to the forties now. Certainly a time when many of us are noticing a lot more aging changes in the face and giving more thought to getting some work done.

Dr. Lawrence Bass (00:36):
That's right. We're definitely beginning to ramp up with the need to actively manage the face before it gets away from us. At this stage, it becomes important to have a regular beauty plan,

Doreen Wu (00:50):
And we'll come back to that. But first, Dr. Bass, can you review the concept of the series Decades of Face?

Dr. Lawrence Bass (00:56):
Sure. There are certain typical changes at certain stages of chronological age and certain typical fixes that work well. We're breaking this down by decade in individual episodes, summarizing what happens at that stage of aging. Now, you as an individual may not show all the changes or quite the degree of severity at a given decade, but you almost certainly will follow the progression of changes as you age, which shows much less variation person to person.

Doreen Wu (01:36):
What are some of these characteristic changes that show up in the forties?

Dr. Lawrence Bass (01:40):
Well, starting with the skin itself, skin is considerably less elastic. It's starting to look duller and rougher. It's thinner. There's less ground substance material, that's the hyaluronic acid in the skin and some other things, and there's less collagen and the organization of the collagen and the elastin is starting to deteriorate. Also, volume loss progresses at first. It helped create a more sculpted look compared to the baby face that many of us have in our twenties. So in our thirties we may have our best look, a little more angular, but as volume loss progresses by the forties, it's definitely too much and it starts to degrade our appearance and produce obvious signs of aging. And examples of this are deepening of the nasolabial fold. Much more distinctive volume loss in the cheeks, the production of a marionette line aligned from the corner of the mouth down to the jawline, and sometimes even early jowling.

Dr. Lawrence Bass (02:53):
There are also a lot of changes in the eyelids, which are almost universally present in people in their forties, at least to some degree in the upper eyelid. This means some hooding and excess of skin in the lower eyelid, some bulging fat that creates the appearance of a bag under the eye and crepiness in that lower eyelid skin. Just little lines and irregularities that degrade the smoothness of that skin in appearance. There's also some deepening of the tear trough or the demarcation line between the eyelid skin and the cheek. Skin forties can also start to show some skin laxity at in the early stage, and some individuals will show some muscle banding in the neck,

Doreen Wu (03:52):
Given that most people start exhibiting these signs of aging by the time they hit their forties. What is the typical beauty plan for those in this decade?

Dr. Lawrence Bass (04:01):
It starts with some good medicated skin products, things that that have retinoid or growth factor, some skin medication, not just a product that protects the skin, but a product that helps improve the biology of the skin. Botox and fillers are almost universally part of the beauty plan in the forties. And energy based treatments as needed for whatever skin changes have become prominent. Pigment irregularity, age spots, redness acne, rosacea may start to show at this age, texture changes in the skin and early wrinkling. And there are also energy based treatments for skin laxity, Things like Ultherapy and others that take the mild skin laxity of a 40 year old and just give that little drop of tighten up by pushing the skin with energy. It's not a replacement for a facelift or a neck lift, but when the laxity is very minimal, this can be a really good way to hold it in check. In the forties, we see a really big uptick in Botox and fillers. So we said from twenties to thirties there was a huge jump, but it jumps again about three times as much use in the forties as in the thirties and a big increase in more aggressive laser treatments like recovery based laser resurfacing or laser peels for wrinkles.

Doreen Wu (05:41):
And why is the beauty plan more essential at this stage?

Dr. Lawrence Bass (05:46):
Well, you want to try to put together a good basic plan. Not going overboard, but doing a few things periodically to maintain the skin and chase the most visible features. Experience has shown the difference between having a beauty plan and having nothing is often a decade delay before surgical interventions are needed to correct facial aging. And even sometimes approaching two decades of delay before surgical intervention, that's a big deal.

Doreen Wu (06:23):
Speaking of surgical interventions, what are the big items in this decade?

Dr. Lawrence Bass (06:28):
So again, looking at the American Society of Plastic Surgeons statistics which breaks down utilization of different procedures by age. Eyelid surgery is the top of the list for face procedures. And as I said, almost everyone has moderate or worse aging changes at this point. So that's a very popular procedure and there are a lot of reasons for that. Again, it's, it's a prominent feature in aging at this point. The surgeries have very little recovery and give a very durable result that may last a decade or even two decades. So that's a great procedure with a big impact on facial appearance. And since people spend about 70% of the time when they're talking to you, looking at your eyes or the area around the eyes, anything you do to approve appearance in that area has a big impact on how you're perceived.

Dr. Lawrence Bass (07:36):
Facelift is starting to be used by some individuals who are either aging poorly or taking a very aggressive approach, but these are often mini lifts, which are more age appropriate at this stage than for later in the game. And sometimes there's just a portion of the face that's showing laxity, and that's really where a mini lift is appropriate. Because it addresses and focuses on the area where the trouble is located. There are also a bunch of more minimal procedures for facial and neck laxity problems. And for contouring these areas, liposuction of the neck and procedures that chase neck banding by either surgically repairing the muscle, sewing it back together, called a platysmaplasty, or things like the trampoline platysmaplasty which goes by the brand name, MyEllevate that divides some of the muscle bands and suspends the submental tissues to sharpen the cervical mental angle, the angle between the jawline and the neck and sharpen jawline definition a little bit. And then there are things like thread lifts again for mild laxity in the brow, the cheek, the jawline or the neck without the magnitude of intervention of an open surgery.

Doreen Wu (09:21):
Does this mean that everyone is going to be slated for surgery in their forties if they want to look their best?

Dr. Lawrence Bass (09:27):
The good news is not necessarily, It depends in part on how you're aging and in part on how much maintenance and prevention you've built into your beauty plan. Predictably, people who are doing a lot of little maintenance treatments stay looking good longer without surgery. More and more as we get modern advances, new techniques, new treatments, we're able to avoid neck and face procedures during the forties. If you've had a good plan of care over time, this is less true for the eyelids, which is more dependent on surgery once the aging changes start to show.

Doreen Wu (10:14):
Before you conclude Dr. Bass, can you share some important takeaways for our listeners about the forties decade?

Dr. Lawrence Bass (10:20):
Don't just play catch when some feature on your face looks really bad or prominent. Make a prospective plan of care. It's okay to do a little bit or a lot depending on your preferences, but you'll be so much better off if you're at least doing something. We all walk around with a mental image of ourselves based on how we looked in our twenties. And the sad news is that in our forties, especially the later half, we definitely no longer look the same. We may think we do, but trust me, we don't. And others see right away that we're no longer a 20 something, that we're a 40 something headed into middle age and no longer a young adult. Finally, this is the time to take a few steps to keep looking good rather than descending into a very worn out aging look that has to be corrected with bigger interventions.

Doreen Wu (11:25):
I could not agree more regular maintenance treatments in our forties can go a long way in keeping us looking youthful and allowing us to stay ahead of the curve. Thank you, Dr. Bass for sharing your insight and expertise with us. And thank you to our listeners for joining us today to hear about how having a beauty plan can help you stay looking younger for longer. I hope you found this episode as fascinating and informative as I did. If you think of other exciting developments or trends in plastic surgery that you would like us to discuss in an upcoming episode, please reach out via email or Instagram. We'll see you next time. This is Doreen Wu thanking you for joining Dr. Bass and me for this discussion of antiaging treatments in your forties. Be sure to tune in next time and don't forget to subscribe to our podcast to stay up to date with all of the exciting content that is coming your way.

Speaker 3 (12:12):
Thank you for joining us in this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor patient relationship is established by listening to or participating in this podcast. Consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.