Decades of Face: The Seventies, The Encore Decade

Doreen Wu (00:00):
Welcome to Park Avenue Plastic Surgery Class, the 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 70's, The Encore Decade." We are approaching the end of our decades of face series. As always, we have another intriguing episode title. What does it mean, Dr. Bass?

Dr. Lawrence Bass (00:35):
If you've been involved with maintaining your appearance, you've been around the block by now. Been there, done that for most of the mainstream treatments and surgeries. A lot of surgery gets done in late fifties or early sixties. By the seventies, it's been 10 to 15 years, sometimes more since the big facial reset of the facelift. This may be the last chance to do something major to improve facial appearance, the last hurrah, and medically it may be time based on what you've done previously to go ahead with another big surgery.

Doreen Wu (01:18):
That makes sense. So what should I be thinking about in terms of surgery?

Dr. Lawrence Bass (01:24):
As I said, it depends on what you've done and when you've done it and how you've been aging since then. By your seventies, you've got a lot of miles on your face. By this point in time, everyone's had a lot of every kind of aging change, but some may have been minimized by previous treatments or surgery. Some may be especially prominent depending on life stress or other bad events or environmental factors like sun exposure. Some people may not have had any surgery by their seventies, so this is the decade probably your last chance to do anything. Many facelift surgeons I know won't operate on anyone over 75. I do operate on patients in their seventies and even their eighties, but they need to be totally healthy and there may be some limitations on the completeness of the results that can be obtained due to the much greater loss of skin elasticity. Still, you can get some major improvements in appearance, and so if you've waited, now is definitely the time for action. Facelift and eyelid plasty are common as either a primary procedure or a secondary procedure, a redo of a facelift from 10 or 20 years ago, and things like laser resurfacing or laser peel can really reduce the amount of wrinkles or fine lines on the face.

Doreen Wu (03:07):
What about people who have already had a facelift or an eyelid plasty? What are things they should consider?

Dr. Lawrence Bass (03:13):
That depends predominantly on how long ago you've had a given procedure and how you've aged since then. Some people do a lot of maintaining starting three or four years after a facelift and others do not. They just coast for a decade or more. Were there any major stressors in your life? Have you had a bad illness or a family tragedy? If you had major weight loss, that could be another factor that would put you in range of a redo procedure sooner rather than later. Typical interval before a secondary facelift is 10 to 15 years. Some patients are lucky and they go a little longer. Other patients are aging a little more quickly and they don't quite make it that long. Eyelid plasty, which is commonly done either before or at the same time as the facelift is amongst the most durable of all of our plastic surgery procedures. In aesthetic plastic surgery, most people can go 15 or even 20 years before a touchup is needed. Sometimes it's never needed. Unfortunately, not everyone hits these target intervals. They represent population averages. A few people are aging faster due to genetics, life stress or environmental factors like sun exposure or smoking. They'll need a secondary procedure earlier than expected. Deep chemical peels, which are not used as commonly today, often don't require re-treatment, but laser peels may after five or more years.

Doreen Wu (05:01):
Okay. That takes care of the big ticket items, the ones involving surgery. Do I need an encore on anything else?

Dr. Lawrence Bass (05:08):
Well, Doreen, as you've heard me say before, maintenance, prevention and restoration continue even after surgery. The seventies are definitely a time to keep up with all the relevant non-surgical treatments. They really can make a major difference in your appearance in your seventies. The challenge is picking things that will have a meaningful impact, both the right treatment and the right amount. Unfortunately, in order to make things work, you have to put more time and effort into it than you did in your forties or fifties. Just like everything else with our health, what worked to keep us healthy before is just not enough at this life stage.

Doreen Wu (05:55):
I see. I want to make sure I cover all the bases, so tell me, what treatments should I be thinking about?

Dr. Lawrence Bass (06:03):
Botox and other neuromodulators like Dysport, Xeomin and Jeuveau work and remember, they'll only clear the dynamic wrinkles, the wrinkles caused by muscle tension, not the fixed or fine wrinkles within the fabric of the skin itself. But as we get older, we might not wake up from that nerve signal block as quickly, and that means that we might get a nice long interval before re-treatment with the Botox. This is an example of one of the very few things in aesthetic plastic surgery that works better as we age. There's unfortunately not many examples of that.

Doreen Wu (06:48):
Got it. What else should I be considering?

Dr. Lawrence Bass (06:51):
Injectable fillers. Again, injectable fillers are part of the beauty plan at any age. Volume loss in the face is accelerating and fillers are a good way to help restore facial shape and volume without surgery, but we're not in single syringe territory anymore. In our thirties, one syringe for a little bit in the folds and the marionette lines might be enough or one syringe in the cheeks when we're a little older. At this stage of the game, budget more volume in your injectable filler treatments and sometimes fat grafting allows more volume and facial shaping in a single session and with more durability than injectable fillers, but some trade off because there's always a little bit of recovery time, bruising and swelling with a fat grafting procedure.

Doreen Wu (07:50):
So far, this sounds like a continuation of the central part of my beauty program for the last few decades. How is it different?

Dr. Lawrence Bass (07:58):
The selection of fillers may be heavier. We may chase more areas and we're definitely going to use more volume, so it's the same idea but expressed in a different way. This is where a partnership with an experienced plastic surgeon really works your advantage because the results with injectable fillers are greatly dependent on the skill of the injector.

Doreen Wu (08:25):
Tell me what else is on the agenda in our seventies?

Dr. Lawrence Bass (08:29):
Skin quality, but now with the big gun treatments, but they're done much more heavily. You may have a little more redness or downtime even if you don't do something that leaves the skin raw.

Doreen Wu (08:44):
I'm not sure I follow. What do you mean by that?

Dr. Lawrence Bass (08:47):
Specifically there are two things we're usually chasing at this stage of the game with energy treatments, and energy treatments means lasers, radio frequency, and sometimes even chemical peels. The first thing is pigment. If we just remove all of the brown sunspots, blend your skin pigmentation even, most people will look decades younger without having any surgery, and this is typically done with a few treatments with no recovery lasers or with a single medium depth laser peel and laser peeling brings me to the second issue: wrinkles. This is the big other aging change in the face after skin laxity. A lot of people don't understand that a facelift is not appreciably correct wrinkles. Laser peels or chemical peels are needed for this. RF microneedling can often help, but at this stage, the heavier treatments are typically needed unless there's been a lot of chasing of wrinkles earlier in the game, so things like lipstick, bleed lines, and crow's feet are obvious signs of aging in later decades, and those are examples of wrinkles.

(10:16):
Sometimes they're showing in a major way in the seventies, but often they've been visible or sometimes even prominence since the fifties. When this extends into the rest of the face, cheek burrows, wrinkles that cascade down the cheeks vertically or sometimes even look cross hatched, it gives a very aged look to the face and this can be minimized or in some cases nearly eliminated with laser peels or laser resurfacing, and that has a drastic effect on apparent age. Totally separate from removing skin laxity in the gel jawline and neck with a facelift or neck lift. My usual approach is laser resurfacing with surgery. The recovery is usually less than the surgery or as a standalone. There's typically about a week of hiding out and then some camouflage makeup for a number of weeks after that, but the transformation is typically dramatic.

Doreen Wu (11:24):
Before we wrap up Dr. Bass, can you give our listeners some important takeaways from today's discussion?

Dr. Lawrence Bass (11:31):
The seventies are the encore time to keep turning the wheel on those things that are part of recurrent maintenance and restoration, but in a heavier way, more doing more an amount and more often. Most important, they're the final Casablanca moment, the time to play it against Sam for the last time when it comes to surgery. While it's not an absolute, the seventies are pretty much use it or lose it forever. Final opportunity. Don't be disheartened. You can still get major improvements in your seventies and again, get yourself to that adult indeterminate stage. Everyone knows you're not twenties, thirties, but they can't quite peg what decade you're in.

(12:33):
Not quite as completely as we can in your fifties or sixties, but still to a major degree if you go to work on it. Surgery is great if you're healthy. Non-surgical treatments are still part of the plan and can give a major boost to your appearance if you're doing them inadequate amounts. If you haven't ever done a big cleanup of pigment or wrinkles, it's a game changer in terms of giving you a more youthful look along with skin laxity, reduction from things like facelift and neck lifting. As always, facial shape and facial volume help give a youthful look and accent your beauty in really pleasing ways.

Doreen Wu (13:18):
Thank you, Dr. Bass for sharing your expertise and giving us valuable insight into how we can combat facial aging in our seventies and turn back the clock. After today's discussion, I now see that replaying working strategies both big and small can help us maintain a great appearance well into the seventies decade. 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.