How young is too young for facial rejuvenation?

Women in their 30’s need the real skinny on whether they should start receiving Botox and fillers, microdermabrasion and laser treatments at a younger age to prevent future wrinkling. Logically, many young women wonder if this might be a bit too early and, hence, a waste of money.

Unfortunately, the clock on the aging process begins upon exit from our mother’s womb. If you look at a baby, they have chubby cheeks with plenty of “baby fat”. There is nothing different about baby fat, it is just fat. That baby fat begins to disappear in the first few years of life. Look at a 5-year-old child; already their face is less full of “baby fat.”

The aging process consists of several components:

• Loss of volume (as just discussed),
• Gravitational descent of facial structures (both skin and fat as well as the deeper contents of the face),
• Skin surface wear and tear and
• Biochemical changes to the skin, such as thinning of the dermis and loss of elasticity.

These changes don’t begin when we hit the milestones of 20, 30, 40 or even 50 years of age. Rather, these changes begin immediately as we begin our lives. So then, the question is, at what age to do what?

There are two approaches: Preventative and Reparative.
Preventative is easy, but you really need your parents to have been proactive. When we are children, the last thing we think about as we go outside and play is to put on our sunscreen. Much of the sun damage that occurs to our skin happens when we are children; too young to know to prevent it. And to those of you who are reading this and have small children, take note. You can protect their skin now.

Ok, so what can you do now? Now it’s time for the reparative activities to repair the damage. Just about everyone has some element of damage to their skin due to sun exposure. It is never too late, nor too early to learn how to protect your skin and use topical agents to repair some of the damage to your skin. A knowledgeable aesthetician can evaluate your skin and make appropriate recommendations. I think that anyone concerned about his of her facial appearance should pursue this. It is easy, painless, not very expensive, and can preserve as much of your appearance in the future as possible. Maybe even undo some of the damage you already have.

Where do Botox and fillers fit in? Botox is a purified protein derivative that relaxes muscle. Although Botox has over 100 medical indications for use, in the face it relaxes the muscles that cause facial lines, hence the lines fade. This happens only for as long as the Botox is working, then the lines come back. Botox lasts about three to four months, so it is advisable to repeat treatments at those intervals to maintain your new look. Fillers, on the other hand, replace lost volume to the face and fill lines that are not due to muscle activity, such as the nasolabial folds, or “smile lines” on your face. Most fillers are temporary, lasting from 4 to 24 months, depending on the particular filler. I personally do not believe in permanent fillers such as silicone as there have been some problems with them, and facial aging continues, so what looks good now, may not look good at all in several years. I think that anyone over 18 years who has concerns about facial lines that would be improved with Botox and/or fillers, or wishes to enhance the fullness of their lips should give consideration to using Botox/fillers.

There are many other non-surgical treatments for facial aging of varying efficacies. It is beyond the purpose of this blog to evaluate each one, but this group includes chemical peels (of which there are several types), microdermabrasion, and radiofrequency treatments. I do not believe that there are any age minimums here either, so if you are over 18, I think that these can be considered. The main thing is to find a knowledgeable plastic surgeon or dermatologist to consult.

There are many different types of laser treatments. Laser treatments and chemical peels are essentially facial resurfacing treatments. By removing the outer layer of the skin, the skin will re-heal by generating a new outer layer. Different peels and laser treatments ablate (remove) the skin to different depths. The deeper you remove the outer layer of skin, the more rejuvenation you get, but there is more downtime and potential for scarring. Young women (and men!) with minimal sun damage can benefit from light peels even while still in their early twenties. As you age, and as there is more damage to the skin from the sun (and there is also a strong genetic and environmental component) deeper peels and lasers may be required. Again, this is best discussed with your dermatologist or plastic surgeon.

The next issue is surgery. The purpose of surgery is to remove excess skin, elevate and re-position structures that have fallen due to gravity and to improve on issues that may have existed even before noticeable aging. Surgical procedures include facelift (rhytidectomy), eyelift (blepharoplasty), browlift, nasal surgery (rhinoplasty) and liposuction (usually the neck and jowls). Most all surgical procedures can be repeated as the aging process continues.

When deciding if it is too early to think about Facelift surgery, I would suggest putting aside your age and just look at the deformity. If your plastic surgeon feels that a substantial improvement can be had with the procedure, then it might be worth proceeding, even if your chronological age may be earlier than you would think would be appropriate for the given procedure. For instance, I have several patients who have consulted me for facelift and eyelid surgery even though they had the surgery 10 or 15 years earlier. The previous surgery is in no way a hindrance to the performance of a quality surgery once again.

The bottom line is to use the technologies at our disposal to maintain your youthful look as long as possible. Each of us ages in our own way. For some, Botox and fillers at 24 is a normal and correct choice. For others with a different set of genes and different habits with the sun, alcohol and tobacco, they may not need this until they are 40. The mirror will give you clues and your board-certified plastic surgeon can help you make the right decisions.

To your health & beauty,
Dr. Mark Epstein

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