Q: Dr. Eppley, I have a few questions regarding facial implants. I did not see this addressed on your blog so thought I would ask. My question is regarding the known/ suspected long term effects of having facial implants if any. While I understand that for instance solid silicone implants such as the jaw/ chin implants I’m interested in will last a lifetime; however, what does the aging process hold for those that have such implants? Does placing an implant under the largest muscle (of the jaw) have drawbacks as I age. ( only in my 30’s now) Will jowls/ sagging skin etc show up faster since the muscle is now stretched over this new ( larger jaw)? How will chewing be effected if at all due to this as I age. Or will aging and its various processes just march on as if I never had anything done and just as if I was born with this new wider jaw and more pronounced chin? Thanks again for your time.
A: Facial implants, of any location, have no negative impact of facial aging and may actually have the reverse effect. As implants add volume by addition to the bone, they may prevent some tissue sag, or delay it, that will inevitably occur with aging. Jaw angle implants have no negative effect on chewing other than the initial discomfort and stiffness in mouth opening right after surgery that persists for a few weeks.
Dr. Barry Eppley
One’s face is revealing of many things, sometimes good and sometimes not so good. Time, genetics, sun, illnesses, smoking, and stress or good fortune all leave their marks on one’s face. Right or wrong, people make instant judgments about one another’s age, health, mood, personality and character based on their facial features. But many things can be gleaned from a face than just a smile or a frown.
Certain medical conditions may be able to be diagnosed just from one’s face. Hypothyroidism can result in hair loss which can be seen in thinning or absent hairs of the eyebrows. A round or clsssic moon-shaped face develops when steroids are taken over a long time or high doses are given for shorter time periods. Small strokes can be detected from changes in facial expressions or laugh lines. Sleepy eyes may be a sign of a neuromuscular disorder known as myasthenia gravis which makes the eyelids droop. The ears can be a tipoff to gout as they can develop bumps under the skin which are crystalline depositions. Pale lips and eyelids can be a sign of anemia. A whitish ring at the colored portion of the eye (iris) may be a sign of high cholesterol.
One’s stated age versus their appearance can alsobe a sign of good or ill health. A youthful look is usually a sign of good health as illnesses tend to make people look older. Even if one look older than their stated age and has no medical illnesses it may also reflect various psychological disorders.
Some research studies show that certain facial anomalies, such as ears with attached lobes, hair whorls, and widely spaced eyes, are related to mental disorders, such as schizophrenia, and to physical characters, such as clumsiness. There is some evidence that structural asymmetries of the face predict hyperactivity and schizophrenia and susceptibility to infectious diseases.
The face is also a well known reflection of one’s age and occurs in a classic triad. First, wrinkles, age spots and tiny spider veins appear which are worsened by long-term sun exposure and smoking. Secondly, a loss of volume appears which is the shrinking of the fat layers in the face, most commonly in the cheeks. This will create a gaunt or deflated look and cause bags under the eyes to stick out more than before. Lastly, certain parts of the face simply drop, the jowls, neck and cheeks sag downward due to stretched out skin and loose ligaments.
But one’s skin color has a huge impact on facial aging. The more pigment you have in your skin, the thicker it is. Thicker skin has more elastic fibers which are more resistant to aging changes. The increased pigment also blocks the sun better. In addition, darker skin has more oil glands so it remains more supple over a lifetime and less prone to wrinkling. These are the advantages that Blacks, Asians, Hispanics and people of Mediterrranean descent have over most Caucasians.
The face is truly a trove of information about our health, age and demeanor. Between good medical care and plastic surgery, one can make their face appear healthy and more youthful.
Dr. Barry Eppley
Q: I am interested in a brow lift or botox treatment…maybe a facelift. I am 43 years old and I believe I look ten years older. Do you know if I could try one procedure now and then gradually work up to a progressive series of surgeries?
A: The wonderful thing about the many procedures for facial rejuvenation is that both small and big changes can be done. And the procedures can be customized to how much one wants to do, how much one wants to spend, and how much recovery one can allow. Since facial aging is a progressive phenomenon, younger patients will need smaller procedures while bigger changes are reserved for those with more loose skin and wrinkles.
Since you have never had any of these cosmetic procedures before, it is understandable that one often does not know where to start. To ‘put your toe in the water’ so to speak, doing something non-surgical like Botox or injectable fillers is a good way to start. One can venture ‘further into the pool’ with laser treatments and even facelift surgery at a later date. A progressive approach to facial aging treatments is both reasonable and prudent.
Always start with the facial concerns that bothers you the most. To get started, it is helpful to meet with a plastic surgeon and have an educational session about what is appropriate now and what may be beneficial in the future.
Dr. Barry Eppley
Q: I am 53 yrs. old and have very deep nasolabial folds (more so on one side than the other). I don’t know why they are so deep at my age but they are. I was interested in the “Cutting out” of the fold, however, my question is what happens to the cheek? Would the skin not sag? This is a problem I have and am very self conscious about it.
A: The development of nasolabial folds occurs in everyone as they age, some are more pronounced than others. How deep and early nasolabial folds appear is a function of numerous factors including thickness of one’s facial skin, thinness or fullness of one’s face, cheek bone support and how much cheek soft tissue sagging or ptosis develops. The nasolabial fold develops as the cheek tissues sag down over the more fixed and stable upper lip region. They are really tissue that is ‘falling over the fence’ so to speak.
By far, the most common treatment for softening the nasolabial folds are injectable fillers. But in advanced stages of nasolabial folds, an inverted-V deformity exists in the skin and injectable fillers do not produce a significant or worthwhile reduction. Usually inverted nasolabial folds are seen in older patients. (> 60 years of age)
In the inverted V or deep nasolabial fold, excision is a treatment option. Because this technique cuts out the fold, it is very effective at restoring a smooth transition between the lip and the cheek again. However, there is a trade-off of a scar which make proper patient selection critical. While this fine line scar does quite well, it is a scar nonetheless and that deformity trade-off is not right for everyone.
Another treatment option for the deep nasolabial fold is a ‘release and fill’ technique. A fine surgical wire is used to release the dermal attachments of the fold and an interface of injectable fat placed under the release. While this sounds like it would be theoretically successful, long-term follow-up has not borne out this theory.
Before considering nasolabial fold excision, one may want to try injectable fillers to be certain that their effect is not sufficient since they are reversible. Nasolabial fold excision is a one-way commitment.
Dr Barry Eppley
As people age, two of the most noteworthy and bothersome facial changes is what occurs along the jaw line and neck. These two changes are usually progressive, first comes the jowls then goes the neck. Like wax melting off of a candle, cheek skin and fat begins to slide off of the face creating those fleshy droopy folds at the jaw line known as the jowls. Recent research also indicates that it is more than just gravity that causes jowls, it is the shrinking of facial fat as well.
The appearance of jowls will eventually occur in everyone with enough time. Jowling creates an undesireable change in facial shape, making it wider and more rectangular in the lower face which is characteristic of an older person. It also causes a distinct disruption of a smooth jaw line from the chin on back, which is characteristic of a more youthful appearance.
Jowl correction is generally part of a facelift procedure. This is done during a facelift by either trimming the jowl fat, suturing the jowl fat back up to a higher level, or some combination of both of these manuevers. Facelifting is a relatively common procedure as evidenced by the 95,000 performed in the U.S. in 2009 according to the American Society of Plastic Surgery.
When only jowls are present and the neck has minimal loose skin, a different variation of a facelift can be done. Scaling back the ‘size’ of the facelift procedure can very effectively eliminate those troublesome jowls. Known by a wide variety of different names, the limited or downsized facelift tucks up the hanging loose jowls with very minimal recovery. Unlike a traditional facelift where incisions are made in front of and on the back of the ears, the jowl facelift only uses a fine incision in the front. The lack of any significant recovery is noted by the different names that are used to describe it, such as Lifestyle Lift, Swiftlift and EZ Lift. Expect one week for the significant recovery period of some mild swelling and bruising.
One of the great advantages of a jowl lift or ‘short scar facelift’ is that it also addresses a common facelift fear, that of looking unnatural. Few patients that I have ever met want to look like they have had a facelift. These procedures have no risk of that ever happening as they deliver a more subtle and less dramatic result. One will never look have that windwept or overdone look as, by definition, the procedure is more limited.