Our Aging Face Part 2: Engaging The Enemy!

This is the second article about the inevitable aging process of our face. In Part 1, I categorized and described the phases of aging according to decade. The Intrinsic and Extrinsic aging pathways were defined; Intrinsic aging is essentially genetic and Extrinsic aging is dependent and influenced by external factors like sun exposure, climate, personal habits and lifestyle. These facets do vary within the population, but their influence on the aging face is undeniable. We have no influence on our genetic side of aging, but can do much to affect, control and manipulate those external factors.

Since the journey of facial aging starts in the second decade and continues relentlessly until death, the following recommendations apply to all ages, with modest tweaks between some decades. I urge younger readers to adopt these guidelines immediately, because you have the most to gain, and are in the best position to slow down the march of time. All others can still do so much to affect the process as well, no matter what decade.

The Basics-No Excuses!

1)  Hydrate-Water really is the "fountain of youth", readily available and ignored by us all. It is the primary chemical component in our body representing 60% of body weight. It helps prevent dry skin, so drink a minimum of eight 8 oz. glasses per day. It has additional benefits, like flushing out your organ systems; think of it as a cheap, simple daily cleanse!

2)  Sun-Lots of sun may give you a ravishing bronze tan but tons of science guarantee that it causes dry, leathery wrinkled skin. Loss of the ozone layer and too much sun increases skin cancer incidence many fold. Use sun block and protective clothing, and if you must tan, do it early or later in the day when the rays are less strong. Don't even consider tanning beds, as they are even worse than natural sun. A great alternative is self-tanners.

3)  Smoking-A no-brainer! Smoking constricts blood vessels to your face, restricting the delivery of important nutrients, hurrying the aging process to warp speed! Studies comparing twins who smoke offer shocking differences from their siblings who don't. One twisted advantage of smoking? Statistics prove that smokers will die from lung cancer or heart disease at a younger age, halting the aging process completely!

4)  Diet and Exercise-A balanced diet, including foods rich in anti-oxidants, help combat free radicals released by pollution in the air. Free radicals contribute greatly to the aging face. Alcohol abuse also speeds aging. Exercise enjoys numerous benefits, like increasing blood flow to the face by increasing the heart rate. Remember the sunscreen and protection when exercising outdoors.

5)  Sleep and Stress-Studies show that lack of sleep and increased stress hastens aging. The body repairs itself during sleep and blood flow to all parts of the body, including the skin, increases during sleep. At least 7-8 hours of sleep is recommended. Stresscauses premature aging by affecting skin at the cellular level, and can promote unhealthy habits like smoking and drinking alcohol. Effective stress busters include, exercise, meditation, yoga, a warm bath and thankfully, sex!

Skin Care-The Real Battle

I present to you a simple yet proven regimen to combat the extrinsic elements aging your skin.

1)  Cleansing-Wash your face after removing makeup in the evening and choose a cleanser that is suited to your skin type. Avoid ones with fragrances, which can be irritating and avoid ordinary soap which can be drying. Don't break the bank, expensive cleansers are not necessary. Don't over-do it. Cleanse after a workout or a day in the polluted city to avoid breakouts, but washing too much dries out the skin by removing natural oils. Don't bother with a toner, as they are alcohol based and can remove natural oils. A good cleanser is all you need.

2)  Exfoliate-Find an exfoliation product that removes debris and dead skin cells but is not too caustic. Pain and irritation after exfoliation exposes a regimen that is too harsh for your skin. Some products may be used with a wash cloth or cleansing pouch to maximize results. Dermatologists recommend exfoliating 1-3 times a week, depending upon skin type and needs.

3)  Moisturize-The cornerstone of a solid skin care routine is finding the right facial moisturizer and using it with frenzy. The first step involves determining your skin type. The options include; dry, oily mature, sensitive, normal, or a combination. The ideal moisturizer includes a sunscreen and marries your skin type with the appropriate active ingredients benefiting it. Other important choices involve specific ingredients and their characteristics like organic vs. natural, with or without fragrance. The most important attribute is one that protects your skin without harmful ingredients. Don't be fooled by fancy advertisements, a good product should also be affordable, so you can use it every day! Specific moisturizers just for the skin around the eyes should be considered after 40, as the skin is thinner and a bit different from surrounding facial skin. When in doubt, consult your dermatologist.

4)  Vitamin A-Topical vitamin A products increase collagen synthesis and tempers discoloration in the skin by peeling away the top dead layer. Essentially, it thickens thinning skin. Retinol is the milder, over-the-counter version and tretinoin or tazarotene is the more concentrated prescription brand. Before age 40, Retinol should be all you need, after that, the stronger tretinoin may be helpful, but consult your plastic surgeon or dermatologist, as you will need a prescription.

5)  Anti-Aging Creams-Still somewhat controversial, these products include ingredients Vitamin C, Retinol, Hydroxy Acids, and anti-oxidants like Coenzyme Q-10. Individually, studies have shown that they help to reduce fine wrinkles and improve skin quality. Effectiveness depends upon concentration of specific ingredients and length of use. For this reason dermatologists opinions vary regarding timing of use.

As you can see, we don't have to sit back and accept our wrinkles without a fight. Let's age with dignity, but at a slower pace!

If I had known I was going to live this long, I would have taken better care of myself." -- Mae West

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The Beauty Quotient Formula

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Ten Reasons to Get a Dog Instead of a Facelift

According to the American Society of Aesthetic Plastic Surgery, American women underwent over 9 million cosmetic procedures last year. Americans spent almost $10.5 billion on cosmetic intervention in 2009. During that same time, some 2 million dogs were euthanized in this country. The Humane Society estimates that animal shelters care for between 6 and 8 million dogs and cats every year in the United States. As a dog lover and dog owner since childhood and a plastic surgeon for some 23 years, I believe I am an expert on the subject of the love of dogs and cosmetic surgery. While a facelift can be a wonderful and satisfying experience, I would like to share with you why I believe getting a dog is a better alternative:

1. They Offer A Lifetime Of Love

The average facelift lasts approximately five to 10 years, depending upon technique and individual's skin type. The average lifespan of a dog, depending on breed and size, is 12.8 years. However, long after your loving dog passes away, the memories of extraordinary times together will live in your heart forever. Once your facelift begins to sag, your only memory will be the price tag to have it re-done!

2. They Are Cheaper Dogs are cheaper than a facelift. The average facelift costs approximately $11,000, depending on the city and surgeon. You can rescue a dog from the shelter for free, and even the most expensive pedigree dog does not cost more than $1,500. Also, you will get a lot more bang for your buck with a dog because a dog will love and appreciate you forever.

3. They Make You Happier

It has been scientifically proven that owning a dog increases your lifespan! Numerous studies have shown that dog ownership lowers your blood pressure, encourages exercise, decreases stress and loneliness, lowers your cholesterol and thus enhances your health. Dogs can sniff out some forms of cancer and recognize early signs of seizures, enabling them to warn their human companion to lie down to prevent injury. To date, no studies have been able to document any of the same health benefits from a facelift.  Road Dog:

4. They Often Have Better Breath

A puppy's breath is special and sweet; your plastic surgeon's breath is a crap-shoot.

5. They Can Be Your Hang-Out Buddy

Your plastic surgeon will hang around for a little while after your facelift, but your dog will happily be your companion and friend offering unconditional love for life.

6. They Won't Cause Talking Behind Your Back

People won't mock and sneer at you behind your back if you get a dog. A facelift?

7. They Fetch

You can teach your dog to do tricks; a facelift, not so much.

8. They Cuddle

After a long day or a horrible emotional experience, you can cuddle up with your dog and feel a lot better; not so with a facelift.

9. They Aren't Nearly As Risky

Possible complications encountered after a facelift include permanent facial nerve injury, poor scarring, bleeding, skin loss or irregularities and infection. The worst complication encountered with a well-loved dog includes an accident on the living room floor or a chewed slipper.

10. They Care

You can train your pet to be a Certified Therapy Dog and partner up with your dog and volunteer your services visiting sick patients in the hospital or troubled children in school. Animal-assisted therapy is a type of therapy that involves an animal with specific characteristics becoming a fundamental part of a person's treatment. It is designed to improve the physical, social, emotional and/or cognitive functioning of the patient, as well as providing educational and motivational effectiveness for participants. The experience is incredibly rewarding. People respond favorably after visiting with a dog; a visit with a facelift just isn't the same!

My first book

The Beauty Quotient Formula

My practice

Our Aging Face

There are few things other than death and taxes that are certain. The aging process is one of them, the inevitable and predictable result of living longer. The manner and degree that we age over the decades of life can be explained, understood and even manipulated by our lifestyle. This is the first of a series of articles about our aging face in which I will detail the changes that occur as we age. The blogs to follow will describe and explain ways to slow the aging process down and will discuss those habits to avoid that most certainly hasten that journey. Try not to become depressed by the changes that I describe, as they are part of the life journey. There are two distinct systems affecting the aging face: intrinsic and extrinsic. Intrinsic or natural aging begins in the mid-20s, and continues steadily throughout life. Genetics plays a key role, allowing us to either blame or thank our parents for their contribution to our wrinkles and bags! Extrinsic aging is a combination of external factors that advance aging activity. These include sun exposure, pollution, gravity and personal habits like smoking and skin care. Let's explore this life-long march through time by each decade. Remember, the descriptions below are generalizations and may vary from individual to individual, dependent upon genetic and extrinsic factors. 20's and 30's Sadly, our skin's intrinsic aging process begins as early as our mid- twenties. Production of collagen, the backbone of skin, decreases. Elastin, the substance that allows skin to snap back into place, starts losing its spring. Dead skin cells do not shed as quickly and the production of new skin cells slow down. Since Intrinsic aging is just beginning, those signs are not yet visible, however some people may demonstrate fine line wrinkles, usually around the eyes. Extrinsic aging factors active during these decades, will affect us significantly later. 40's Extrinsic and intrinsic factors progress and contribute to age the skin. Decreasing hormone levels begin to influence skin, increasing dryness. Fine lines deepen, especially around the eyes (crow's feet), forehead and mouth. The lower eyelids may experience bulging of subcutaneous fat, forming bags, and the skin in general, becomes drier and less elastic. Skin pore size may increase and become noticeable. Early signs of jowl formation are seen. Extreme weight loss propagates loose, hanging skin because of the loss of elasticity. The fatty layer beneath the skin starts to decrease, making it appear thin and transparent. Hair starts turning gray. Hair loss for men and women can become evident. 50's Wrinkles deepen and become folds or furrows around the mouth, forehead and face. Facial bone and fat mass decrease, causing sagging skin to appear more prominent. Jowl formation of the cheeks increase and skin tone becomes more uneven. Eyebrows droop, increasing upper eyelid skin redundancy, creating a fatigued or angry appearance. Lower eyelid bags become more noticeable. Neck skin starts to sag and muscles beneath become prominent. Skin becomes drier and sun spots turn darker and more prevalent. 60's Continued reduction of facial fat and bone structure causes the cheeks and eye sockets to appear even more hollowed. This process, along with the help of compounded years of gravity, cause facial skin to appear even more lax. Menopause and decreased hormones maximize dry skin. Facial wrinkles and furrows deepen, especially the smile lines of the mid-face called nasolabial folds. Jowls become heavy. Aging of the neck continues with thinning skin allowing underlying separated muscle bands to appear more conspicuous. Hair thinning and loss continues and the nasal tip loses elasticity, and begins to droop. Even our ears change with age! Gravity's effect on our earlobes stretch them and actually increases the size of our ears. 70's and Beyond All of the above conditions continue to progress. The combination of loss of skin elasticity, decreased mass of facial fat, bone and muscle and relentless gravity deepen wrinkles and furrows as our face seems to actually droop. This can cause the lower eyelids to pull away from their protective position next to the eyeball, causing dry eyes and allow irritants like dust to cause chronic discomfort. The nose and ears appear larger because of loss of cartilage strength. So there you have it, we are born, and not long after we begin to age and look older! It is part of life that we have little control, or do we? The extrinsic, external facet of the aging process can be affected and slowed by a solid skin lifestyle. Check soon for Our Aging Face, Part 2, where I will share tips to create a substantial skin care regimen for all age groups to battle and defy the inevitability of looking older as we grow older! Do not regret growing older. It is a privilege denied to many.

My first book

The Beauty Quotient Formula

My practice

What is your Beauty Quotient

In my 25-year career as a plastic surgeon, I have focused on helping women understand that surgery isn't the only road-map to looking and feeling great. That is why I wrote The Beauty Quotient Formula; to guide women through a healthy, comprehensive way to look at beauty. Think of your Beauty Quotient (BQ) score as a sort of lifestyle surgeon, without a scalpel! After answering all the questions, you will be given your own BQ score. It will tell you your strengths and help you identify areas that need a little bit of improvement.

Take the quiz.

My first book

The Beauty Quotient Formula

My practice

Warning Signs of Narcissism and Appearance Obsession

A wrinkle here, a sag there—for some women, it's just the aging process. For others, a less-than-perfect face or figure can bring on anxiety, depression and obsession. In this blog, I will explain the difference between healthy vanity and narcissism. Can you tell the difference? Take the quiz.

Most plastic surgeons develop a sixth sense when talking to new patients. We size up the body language, how comfortable patients seem, how willing they are to discuss their hopes and fears and how realistic their expectations are. Certain key phrases are giveaways that these patients might be better served by a competent therapist than a surgeon.

"I need this done. I have to have this procedure."
Whenever I hear that, I gently explain that cosmetic surgery is called elective for a reason. It's not necessary from a medical standpoint. No one will die without this procedure.

At that point, I'm looking for more cues that a patient might be suffering from depression. Few come out and admit that they are. They might not list antidepressants on their medical form if they don't want me to know. So I'll try to steer our conversation toward acknowledging that depression might be an issue, and I make it clear that I won't operate on them unless they see a therapist first.

"I need a guarantee that I'm going to look like this."
I'll explain that cosmetic surgery (and medicine in general, for that matter) is not an exact science and that everybody is different. Some people heal well after complicated surgery, and some don't. If patients still demand a guarantee, no matter what the procedure, then I'll just say that I can't help them.

"I only want a correction of 1.2 millimeters."
Anyone who has measured any part of their body down to a fraction may be suffering from body dysmorphic disorder, which is a fixation on perceived "deformities" that in reality are absolutely normal. Body dysmorphic disorder can become dangerous if not treated with therapy, as sufferers can continue to demand surgery and other procedures from less-than-ethical surgeons or physicians, to the point where the damage cannot be undone.

"I want to look young again, like when I was a teenager."
Having unrealistic expectations of what surgery can do to make you look younger is a typical warning sign of narcissism. It is also one of the most common comments I hear from patients who expect to erase decades from their appearance. Not only is this impossible, it is a warning sign to me that there are deep-seated psychological issues to address. Sure, we all want to turn back the clock a little, but expecting to look like a college freshman when your granddaughter is a college freshman is not going to happen!

I also notice this right away with someone who immediately talks about extremes, such as an especially petite woman who wants incredibly large breasts. She's likely to already have a high standard of self-esteem and knows she already looks good. She just wants to do something to be noticed, not for her, but for an external quality. That's crossing over the line into narcissistic thinking. 

My first book

The Beauty Quotient Formula

My practice