While the world has slowed down due to the Covid-19 pandemic, many plastic surgeons find themselves busier than ever. In the new ‘Zoom era’ of video-conferencing, patients find themselves increasingly face-to-face with themselves. Whether you use Zoom, Teams, or FaceTime, are online for work or to keep in touch with friends and family, you’ve probably seen yourself more of yourself in the last year. These video platforms typically require your face to be closer to the camera than you would be for a normal photo or in-person conversation. Close recording proximity paired with high-resolution features on even the most basic camera technology available today, results in patients noticing evidence of aging never so clearly highlighted before.
What are the earliest signs of aging?
As we age, cellular changes are occurring at every level of our anatomy. This starts with alterations in the components of the skin, laxity and drooping of the soft tissues beneath the skin, and even volume loss or resorption of the bones of the face. The earliest signs of aging occur at the most superficial or outer layer of the skin. Increased laxity and loss of collagen are hallmarks of aging. You may notice changes in color or uneven pigment from sun exposure or old acne scars. The texture of the skin may become less smooth and fine lines begin to form.
With increasing age, the ligaments that keep the soft tissues (eg muscle and fat) supported between the bony skeleton of the face and the overlying skin, begin to lose their elasticity. This increase in laxity results in drooping of both the soft tissue and overlying skin. This process turns fine lines into deeper wrinkles. You may notice deepening of the nasolabial folds and development of ‘jowls’ or sagging tissue near the mouth and jawline. With advanced age, even the bone of the face begins to resorb or lose volume. This results in a hollowed out and tired look.
When do the earliest signs of aging begin?
The aging process is natural, it affects us all, and it begins in our 20s. With increased sun exposure and without good preventative treatments it begins earlier and progresses faster. Genetics play a role here too, some people are just blessed.
What can you do to reduce the appearance of aging and increase confidence on video calls?
There has been a massive increase in the skin care product lines available. More important than the brand, is the ingredient. A top-notch skin care regimen starts with aggressive sun protection. As someone who likes to surf, it’s hard for me to advocate total sun avoidance, but daily SPF should be at the core of any skin care regimen. To maintain volume and brightness, hyaluronic acid and Vitamin C serums have been showed to provide significant benefit when used daily. Retinol is one of the most effective anti-aging ingredients available but should be used with guidance of a healthcare professional and not used during pregnancy, breast feeding, or if trying to conceive. Sun protection becomes even more critical if you are using retinol.
Minimally Invasive Procedures.
One of the most common visits to my office is for Botox and fillers. Botox is an injectable medication that weakens muscles contraction. Fine lines and wrinkles in the brow, forehead, and crow’s feet form over time from repetitive muscle contraction. By injecting Botox, which is one brand name for botulinum toxin A, the muscles beneath the skin of the forehead and by the eyes can be weakened, thus relieving the wrinkling effect on the overlying skin. This is both a treatment and a preventative therapy. If you start Botox before the wrinkles form, you can prevent them from forming. If you already have wrinkles in this area, treating with Botox can eliminate or reduce the appearance.
In contrast to Botox, fillers have no paralyzing effect. Fillers do exactly what they sound like they do. They fill space to treat the volume loss that occurs as we age. The most common type of filler is hyaluronic acid which is packaged as several different brand names eg Restylane, Juvederm. Filler can be used to restore cheek volume, fill deflated or small lips, or to treat hollowing under the eyes. Filler is most commonly used in the lower part of the face while Botox is most commonly used in the upper part of the face. Be aware, as tempting as it may be to seek under-eye filler, this can be a tricky area to treat and many patients are better treated with a surgical procedure called a lower eyelid blepharoplasty. Be sure to select experienced and highly trained injectors if you seek this route.
Collagen stimulation. One of my favorite procedures is microneedling with platelet rich plasma. This is a preferred treatment because it uses your body’s own natural resourcesand biochemical reactions to stimulate collage production. After numbing cream has been applied to the skin, a microneedling device uses very small needles to create entry points in the skin of the face for application of platelet rich plasma, also known as PRP. PRP is your own blood, drawn in the clinic, which is then spun in a centrifuge so that only the portion of the blood rich in platelets is used. PRP is rich in factors that promote growth, healing, and collagen production. Down time is less than one day and the results are long lasting. This is a great treatment for both anti-aging and acne scarring.
Almost as often as I have provided anti-aging medical treatments, I have provided anti-aging IT support. Did you know some video conferencing platforms, like Zoom, have filters that touch up your appearance? Some of my patients who come in thinking they need a procedure, are happy to learn that a simple click of a button will freshen up their look. An ingenious software algorithm located under the ‘video settings’ tab, reduces on-screen self-consciousness so they can focus their energies, with confidence, on the professional and personal tasks at hand.
Final note. There is nothing wrong with aging. Aging means you are living. What I most commonly encounter, and love treating, is patients wanting to match how they look with how young they feel. It’s all about choosing what’s right for you.
Roxana Moayer, MD is a facial plastic and microvascular reconstructive surgeon. Her clinical specialties include treatment of facial nerve disorders and synkinesis, facelift and neck lift, rhinoplasty, blepharoplasty, brow lift, cosmetic facial skin treatments including microneedling and PRP, facial reconstruction (following trauma and cancer), hair restoration, facial feminization, and otoplasty. She is dedicated to helping patients look like the best version of themselves, driven by a strong belief that such work is inextricably linked to their self-confidence and overall health. Her attention to detail and aesthetic eye, paired with advanced training in cutting-edge techniques, allows her to deliver reliable, safe and natural-looking results.
After completing her medical doctorate at the Keck School of Medicine of USC, Dr. Moayer continued to the University of California, Los Angeles to complete her internship and residency. From there, she moved to Philadelphia for an additional year of training at one of the highest volume, AAFPRS-accredited fellowship training programs in the country, Jefferson Facial Plastics. She is currently an assistant professor on faculty at the Keck School of Medicine in the Department of Otolaryngology Head & Neck Surgery.
Dr. Moayer is also involved in the Face-To-Face program, an organization affiliated with The Break the Silence Foundation against domestic violence that provides plastic surgery treatment for survivors of domestic abuse.