Maintain vs. Restore

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 "Maintain vs. Restore." I understand this title, it's more straightforward than usual, but perhaps you can explain the intent behind this episode, Dr. Bass.

Dr. Lawrence Bass (00:33):
Basically this is an episode about planning and it's another way of thinking about the need to plan and how to plan so you get the most out of your plastic surgery, you get the most out of whatever your budget might be and however much time you can invest in the process.

Doreen Wu (00:54):
I see. I think I know where we're going here. So let's get into the meat of the topic. What are the options that we have?

Dr. Lawrence Bass (01:02):
So in reconstructive plastic surgery, we classically have this reconstructive ladder. We start with the simplest, easiest things, the smallest surgery with the least risk, and based on the severity of the problem, we progress. If a simple reconstruction is not likely to work, we pick something more complex, but we don't start with the most complex reconstruction. So in aesthetics, I mean we're not reconstructing, but let's use the word restore so we can do things to fix something that's already gone awry. Some aging has taken place. It's something that we don't like looking at. It's visible. We see it, our friends and coworkers see it, so we have to change something. Ideally before we get to that point, we're doing things to maintain our appearance, to keep us from aging or let us age at the slowest rate possible and things to prevent aging, and so it's not one or the other.

(02:26):
We're obviously going to do several things and early in the game, we're going to do things to prevent and then we're going to do some prevention and maintenance, and eventually we're going to have to do some prevention and maintenance with some restoration. And that could be surgical or it could be nonsurgical, but some kind of treatment that's actually going to fix a problem. And so we're going to slowly progress to more restoration as we age, but we're still going to need prevention and maintenance. So it's not one or the other. There's a balance and that balance shifts.

Doreen Wu (03:08):
And how does that change or shift depending on your age?

Dr. Lawrence Bass (03:12):
So as I mentioned, we're going to start off with prevention and we're going to add on and we'll start abandoning treatments and maintenance things that are no longer helpful. There are a few things that kind of drop off, but mostly we're adding new things, either bigger treatments, but we're keeping some of the prevention and maintenance. And so an example might be like sunscreen, that's prevention and you're going to add to that, but you're not going to stop using sunscreen.

Doreen Wu (03:46):
So now let's put aside age. Can you give me some overarching guiding principles for how planning should be done regardless of age?

Dr. Lawrence Bass (03:54):
Well you start with what your needs are, what you're starting to see or beauty issues that you're most concerned with. And everyone's a little different. Some people come in and they say, I don't mind my crow's feet. I earned them, but I hate that loose skin. I'm starting to get under my chin or the jowl. I'm starting to see other patients say, I hate the crow's feet, but I don't mind my jawline. And other people come in and say, fix everything. So it starts with what you are seeing and what bothers you, and you intersect that with your budget and an assessment by your plastic surgeon about what the plastic surgeon sees and what's a prominent feature in your appearance at this time. The other thing that the plastic surgeon can help you with, because you may not know quite as well as someone who spent 20, 30 years working on aging faces, you may not know what's coming soon, but your plastic surgeon probably does.

(05:07):
And so that's useful to help you with planning. You don't want to do an energy-based skin lifting treatment if you think you're doing a minimally invasive treatment for your neck in the next year, you're going to save that money and budget it towards the minimally invasive procedure. So you wouldn't do ulthera or soft wave if you know you're going to be doing something like myEllevate or submentoplasty something surgical in the next year because you know you're getting to that point where you're going to have to pull the trigger on something surgical so your plastic surgeon can advise you what features are starting to show, what features are likely to show in the next few years, and that helps you set priorities.

Doreen Wu (06:01):
You've alluded to some procedures related to the face so far, but can you now tell us how does planning work in the face area and the neck, and can you give us some common examples to help us understand more clearly?

Dr. Lawrence Bass (06:16):
So let's start with laxity. Laxity is the ultimate concern that we end up with sooner or later loose skin in the jawline, the gel hanging in the neck. And so the big question is always when is it time for the facelift or the neck lift? And some people are hoping they're never going to have to do it. For people that are in their twenties, thirties, I don't know what the options are going to be when they get to the stage where they might need it. For people who are somewhat older, somewhere between now and the time you're a hundred, if you want to look your best, you're going to need that surgical facelift or neck lift. Now you may choose never to do it, but medically there isn't going to be any other way to meaningfully correct that. However, before we get to that point where we have a great deal of redundant skin, we have a lot of ways of reversing or restoring some of the skin laxity and maintaining that.

(07:26):
So going forward you age more slowly. And so that starts with externally applied energy, things like Ultherapy and Sofwave, internally applied energy designed to stimulate the skin to tighten up things like FaceTite, AccuTite, things like minimally invasive procedures that are done under local anesthesia, through needle punctures, thread lifts and MyEllevate, which has very good durability and the greater degree of correction. And then eventually you're into the formal surgical lifting. Skin surface changes are another example where there's this wide array and sort of a progression. So as you start to see rough texture wrinkles in the skin, you may be using home skin products and that makes sense, retinoid or a growth factor product. And of course we already said you're using your sunscreen since you were in your twenties or hopefully since your childhood.

(08:39):
But then when you start to see more things, you need to get something medical into the program. It may be a series of in-office, superficial chemical peels. It may be energy-based treatments like radiofrequency microneedling or fractional laser resurfacing. And by ironing out small changes, we hope we can put off or possibly avoid the need for deep chemical peel or a full field deep laser resurfacing, which has significant recovery associated with it. Now if you're 80 and you lived in Florida your whole life and there was no sunscreen when you were a child, you might need that full field laser resurfacing. But if you're 40 or 50 and you're doing some of these light peels, energy based restorations, and then you every once in a while do a little bit to maintain that in terms of in-office treatment, you may be able to avoid ever going for that big laser resurfacing. So things like that illustrate how that maintenance is both part of the plan before and after a big treatment, but may modulate whether or not you need the big treatment and certainly modulates when you are going to need it.

Doreen Wu (10:15):
So we've covered the progression of treatments in the face. How does this work on the body?

Dr. Lawrence Bass (10:21):
So body contouring is one of several components that are part of a lifestyle if you're concerned about keeping your body shape in a range that you find attractive. So it's partly about sensible diet. It's partly about a certain amount of exercise, but there's certain stubborn areas that are just notorious for not dieting or exercising where that even very trim and fit people will manifest, and that's what body contouring is ideally for. There are surgical options like liposuction, tummy tucks, thigh lifts, there, non-surgical options like CoolSculpting, SculpSure and several others, but all of these are going to knock a shape back where you want it. That's kind of come out of range. So everyone walks around thinking, okay, I'm just going to get my shape the way I want it and then I'm good forever and realistically, that's not how life works. Everybody has more than one shape challenge or contour challenge in their lifetime.

(11:41):
Maybe you get pregnant, maybe you sprain an ankle and don't go to the gym for a month or two. Maybe you're busy at work or have some life stress and eating more than usual and exercising less. So it's always a continuous process of maintenance because the body is always changing and in particular at different life stages, you're going to have a different body shape even if your weight on the scale is exactly stable, your body shape is going to change, particularly at pregnancy and menopause, big shape changes. I have ladies that come into my office lighter than they were before they had a baby, but their body shape is different and it's different in ways they don't always like that we have to chase a little bit. So that's a little bit of how maintenance and restoration work in body contouring.

Doreen Wu (12:45):
Lastly, Dr. Bass, before we wrap up, can you give our listeners some parting takeaways from this episode?

Dr. Lawrence Bass (12:50):
Yes. Again, it's about this thought process, how you're going to do things. So first, recognize that planning is key. You're going to be more efficient, get much more out of what you're trying to do, be much more successful at achieving your goals If you spend a little bit of time and effort planning with your plastic surgeon, prevention is essential. These are lifestyle choices that we hopefully adopt early in life and maintain eating sensibly, not smoking, wearing sunscreen. Just certain basic practical things that contribute to our health and wellbeing also contribute to a great extent to our appearance. Maintenance is a great idea and dedicating some time and budget to maintenance activities is a good thing, but you don't want to be so obsessed with maintenance that you disrupt your life. I'm in New York, New Yorkers are busy. Most of us don't want to play with our skin for three hours a day, but if you put on a product after washing up in the morning and you put on a product after washing up before bed, you can probably do 90% of what you could do with a much more extensive regimen.

(14:18):
Finally, try to restore when it's needed, not when it's screaming to be done. You get less return on the investment. If a restoration is done very late in the game, it's not going to correct as completely, it's not going to correct as durably if you wait till it's screaming to be done. It's much more practical to say, I know I'm going to do it sooner or later. And when you are noticing the changes that translate to a particular procedure, then you resign yourself that it's time to proceed. And again, your plastic surgeon is your best advisor when these things are appropriate and when it's too soon and you don't want to use your big playing card yet.

Doreen Wu (15:11):
Many important points that were raised there. Thank you Dr. Bass for sharing your insight and expertise with us. 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.