New Year, New You

It happens to everyone. One day you look in the mirror and the face you see is not what it once was. For those who want to freshen their face or body, doctors today have an arsenal of cosmetic procedures and surgeries that can reverse the hands of time.

Take fillers. There are new products that continue to come out every year, with different properties focused on different regions of the face. The same is true with neurotoxins such as Botox. The results with some of these products can last a year.

“I couldn’t believe it, but two years ago, at age 52, it seemed that my wrinkles were suddenly worse,” says Maryland resident Mary*. “I knew I had to do something about it. I wanted to look natural and refreshed, not fake like so many celebrities. And I couldn’t afford any downtime.”

Being a nurse, Mary did her research. She looked for a doctor who was board-certified, had a conservative approach, would show her pictures of patients before and after the treatment, and have an ongoing dialogue before and during treatment. After a discussion with her chosen doctor, Mary started with fillers.

Maryland resident Pam*, age 71, feels that it is important to look young and vibrant. “I own an automotive wholesale parts marketing and advertising company,” she explains. “I’m out in public and calling on customers every day. I have to look like I’m young enough to make it happen,” she says with a smile.

Pam started getting fillers at age 50. “I never felt my face was distorted,” she says. “It’s very natural looking. Of course, I don’t ask people how old they think I look, but when it does come up, they usually guess late 50s. They are shocked when I say 71.”

Maryland dermatologist Dr. Robert Weiss, who does many clinical trials and is both Mary and Pam’s doctor, says, “I believe in taking a conservative approach. You can always add more later.”

Pam admits that the product is expensive. But, “if it ever came to not affording fillers, I’d practically give up everything to keep getting them,” she says with a laugh.

PUCKER UP

Remember when no one wore lipstick while masking up during the pandemic? Well, the lips are now back front and center. Brittany*, 26, says that she never liked her lips. She sought the expertise of plastic surgeon Dr. Steven Rottman, who helped her lips achieve a symmetrical appearance. “It gave me so much more confidence and they are not overdone,” she says.

For the first-time, lip augmentation with fillers secured a spot in the top five most sought-after minimally invasive treatments, according to the American Society of Plastic Surgeons (ASPS). It should come as no surprise; for older people, lips are a very rejuvenating feature, and are beautiful and appear very natural when done proportionally. In 2020, the FDA approved Restylane Kysse for use for natural-looking fuller lips and the correction of upper wrinkles around them. Unlike some products, Restyle Kysse is noted for allowing more flexibility and a natural feel when talking and kissing.

GETTING RID OF THE ELEVENS

Botox, a neurotoxin that temporarily “freezes” the muscles, can soften stubborn horizontal lines on the forehead, crow’s feet, and take care of what’s known as the “elevens,” those entrenched lines between the brows. Botox, Dysport, and Xeomin have now been joined by the newest neurotoxin, Daxxify. Approved in September 2022, it reportedly lasts longer, allowing patients to come in twice a year instead of four. Of course, it’s more expensive, but for some people time is more precious than price. According to Maryland plastic surgeon Dr. Michele Shermak, Botox is the most used product, followed by Dysport, but clinicians and patients are following Daxxify to see how long it really lasts.

Patient Brittany says, “I didn’t wear sunscreen, and started to get lines on my forehead.” She got Botox for her forehead and the elevens. According to doctors, they are seeing younger patients in their 20s and 30s coming in for Botox. Weiss calls this “pretox,” wherein a patient is given a lower dose of Botox to help prevent future lines. And Botox done correctly doesn’t leave the face looking frozen, like the expressionless robot look that so many people had years ago.

“Today pretty much every reporter, male or female, has had a little bit of Botox in the eleven area to keep that angry look away,” says Weiss. “But none of them are overfilled.”

And many doctors use neurotoxins off-label, including for the tip of the nose to give the appearance of a “nose lift,” because the nose sags with age.

They can also be used in the neck to make horizontal lines disappear, soften the jawline and chin to create a slimmer jaw, improve the appearance of jowls, and for marionette lines. Sometimes dermal fillers are added to these procedures.

According to the American Society of Plastic Surgeons, nearly 23.7 million cosmetic, minimally invasive procedures were performed in 2022. These are some of the leading procedures:

• Neuromodulator Injections
• Hyaluronic Acid Fillers
• Skin Resurfacing
• Skin Treatment
• Combination Lasers
• Lip Augmentation with Injection Materials

PICKING YOUR PRO
Here are questions to ask before selecting a doctor for your cosmetic procedures, according to the ASPS and the American Board of Cosmetic Surgery.

• Are you board-certified in cosmetic surgery?

• Who will perform the procedure?

• How frequently and how many of these procedures do you perform?

• Where will the procedure be performed (for more involved treatments)?

• How much will the procedure cost?

• Are there any risks?

• Is there any downtime?

• What kind of results should I expect?

• How long will the results last?

• Does the price seem to be too much of a bargain? If yes, it should raise a red flag.

• Have you seen before and after pictures?

AVOIDING OVERFILL

Recently, a lot has been written about “filler fatigue”—overindulging in hyaluronic acid fillers in the lips, cheeks, nasolabial fold, or any place on the face. It comes after a person has an overfilled face to accomplish plumper features. Celebrity Courteney Cox was one such person who admitted that she had gone overboard and consequently had the fillers dissolved.

“Some offices have been referred to as ‘fill mills,’” says Weiss. “Fillers were overdone and often put in incorrectly, resulting in a person looking unnatural and no longer like themselves. It’s very important that the doctor has a very good understanding of the anatomy of the face.”

While over the years many people have been turned off of fillers and Botox, the trend is not over. According to Shermak, “I have not seen a reduction. In fact, our [ASPS’s] statistics show that the appetite for injectables continues to grow.” Shermak explains that the goal is to leave people guessing as to whether or not that refreshed look came from a physician. “We aim for natural, refreshed results that are enhancing, not altering,” she states. Use of fillers and Botox can also prolong the need for a facelift.

CHOOSING A FACELIFT

Of course, some people do not want to be tied to injectables for years and opt for a facelift. Today, Shermak has found that people are coming in at an earlier age. “Most come in in their 50s or 60s, but we also see women in their 30s or 40s looking for a facelift to improve the contours of their face or for other facial contouring procedures like neck liposuction.”

Shermak says a person’s health is more important than their age when it comes to surgery. “We could operate on an 80-year-old if they’re healthy, and they seem like a qualified, competent patient.”

She adds that, “Patients come in for a consultation for all different reasons—they look tired, look angry, hate their neck, do not like how they look in photos or online in Zoom conferences, or are preparing for a big event like a wedding.” According to ASPS, most patients’ goal is to turn back the proverbial clock, but in a way that leaves them looking natural—but better.

Joellyn*, 71, is a patient of Shermak. Although a non-smoker, she had lung cancer followed by the removal of a non-cancerous growth on her eye. She says this left her looking, “funky in a bad way and tired. I hated looking in the mirror.”

“Cancer ages you, both mentally and physically,” she continues. “All the stress showed on my face and since I had lost so much weight, my face sagged.” Joellyn had a facelift, eyelift, and a neck procedure. “Afterwards, I loved how I looked—no longer tired, nor any sagging skin, and my neck was nice and tight. It makes me feel better knowing that I look better.”

According to Shermak, recovery from a facelift is faster than breast and body surgery. “In one week, after stitches are removed, patients are typically free to do nonstrenuous, routine activities. By two weeks, the patient should look good, and by a month, great.” According to ASPS, facelifts last on average eight to 10 years. To help make a facelift last, Shermak reminds patients to eat healthy, avoid the sun when possible, use products like Retin-A, Vitamin C, serums, and moisturizers, and to always wear sunscreen.

THE MOMMY MAKEOVER

Maryland resident Becky*, 47, says, “Although I worked out for years and ate properly, I still couldn’t get back to my pre-pregnancy shape.” Realizing she had to do something differently, Becky asked friends for recommendations for a plastic surgeon. After having a consultation with Rottman, she decided to have what is called a “Mommy Makeover.”

According to ASPS, the goal of a Mommy Makeover is to restore the shape and appearance of a woman’s body after childbearing. It can involve a tummy tuck—removing fat, skin, and tightening muscles—liposuction and, for the breasts, just a lift or having an implant to restore firmness. For some patients it may call for a breast reduction, while others wish to enlarge their breasts. Mommy Makeovers have become incredibly popular over the last decade, according to ASPS, as it allows plastic surgeons to address multiple problem areas in a single surgery. Since time is often our most valuable commodity, any procedure that can safely and effectively rejuvenate more than one area at a time—the abdomen and the breasts, for example—is exciting.

Becky had a breast lift, tummy tuck, and liposuction on her back and flanks and says, “My clothes fit so much better. There are no more bulges. I just love how I look.”

Today, whatever part of your face and body you want to improve or rejuvenate, there’s a procedure for it.

*Names withheld for privacy.