Face Time

From ponytail-friendly face-lifts to nonsurgical nose jobs, there are plenty of options for a younger, more radiant you
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Who hasn’t glanced in the mirror and noticed a few signs of a life well lived—albeit with perhaps a bit too much sun exposure? If you’ve put off having any “work” done because you’re worried about a long, painful recovery or bad results, rest easy. Today, plastic surgeons are using smaller instruments and less anesthesia, so recovery time is often minimal. Surgeons are achieving such precise and, in some cases, long-lasting results that even people in their 40s are taking the plunge.

“Face-lifts used to be good for eight to 10 years; now their results can last 10 to 15 years,” says Darrick Antell, M.D., assistant clinical professor of surgery at Columbia University in New York City and a plastic surgeon in private practice. No matter your problem areas, there are safe and effective solutions. Here’s a rundown of the most cutting-edge procedures for your face and neck:

LIPS: As you age, your lips become thinner. One solution? Gel fillers such as Restylane and Juvederm, which can add fullness and definition. Using a tiny needle, a practitioner injects the filler into your lips. The procedure is done in an exam room, and patients may actually be able to participate. “I give my patients a mirror while I work, and I ask them if they want to stop or add more,” says Dr. Antell. Although you may experience bruising, there is no downtime with this procedure—you’ll be able to go out to dinner afterward, says the doctor. Results last about four months. Your own fat—often from your abdomen or inner thigh—can also be used. The advantage here is that the results may be more long-lasting, says David Abramson, M.D., a plastic surgeon in Englewood. The downside? This is more complicated because the fat must be removed from another part of your body before it can be injected.

Also, it can be lumpy. “It’s better for your doctor to inject the fat in other areas of your face before he tries your lips,” says Dr. Abramson.

EYES:

Got crow’s feet—those lines in the outer corner of your eyes— when you smile? Or frown lines (often referred to as the number “11”) between your eyebrows? A common remedy involves injecting botulinum toxin, a type of bacteria that has been highly purified and diluted and temporarily weakens the facial muscles that cause the wrinkles. Both Botox and Dysport (two brands of botulinum toxin) can help reduce these wrinkles. Side effects may occur and may include temporary bruising and, in very rare circumstances, droopy eyelids. Benefits of the procedure last four to five months.

If you have bags under your eyes that make you look chronically tired, you probably have excess fat in that area. These days, doctors can eliminate the puffiness with a minimally invasive eyelid procedure known as fat-melting blepharoplasty, in which a laser is used to vaporize the fat pockets. “There’s no incision, and there are no stitches,” says Dr. Antell. While you may experience temporary bruising and swelling, the effects are long-lasting, says Dr. Antell.

Other doctors are repositioning fat or adding fat or filler to smooth the areas around the upper and lower eyelids, says Dr. Abramson. “If you take out too much fat, a patient may develop a hollow appearance eight to 10 years later,” he says. That’s because your face typically thins as you age. To smooth wrinkles, Dr. Abramson often injects fillers or a patient’s own fat into the area where the eyelid meets the cheek. “This restores a youthful appearance,” he says. The effects can last six to nine months, but they may be more enduring if a person’s own fat is used, says Dr. Abramson. Risks include eye and blood-vessel injuries.

NOSE:

The trend is toward less invasive procedures, says Dr. Antell. So, if you’re self-conscious about the tip of your nose—perhaps you feel it’s too broad or chubby—you can undergo finesse rhinoplasty, in which a doctor thins the tip of the nose without breaking any bones. There’s no bruising, and you can be back to work in a few days, says Dr. Antell. Since the procedure changes the architecture of your nose, the results last forever.

Cartilage grafts are being used to give the tip of the nose more definition, says Dr. Abramson. “A lot of people don’t have enough tip support,” he says. The cartilage comes from the nasal septum, the ear or even the rib, and it’s permanent. Risks include improper healing— and the cartilage can change shape.

Also, Radiesse, a filler, can be used to make a bump on the nose less visible.

NECK:

For plump or droopy flesh under your lower jaw—also known as jowls—there are many options. With microliposuction, doctors can vacuum out microscopic fat and tighten the skin without any stitches. Bruising is the main risk, and there’s no recovery involved, says Dr. Antell.

Keep in mind that “there have been a lot of attempts to do nonoperative things to the neck,” says Dr. Abramson, but they haven’t yet demonstrated lasting success. Sometimes, for the best results, surgery is the answer. With a neck lift, the surgeon tightens the muscles of the neck, removes any fat and reshapes the jaw line. For men, Dr. Antell does what he calls a “wattle-ectomy,” in which he removes excess fat underneath the chin with a zigzag incision, which helps break up the scar. The procedure is done under local anesthesia, and the person can be back at work in a few days, says Dr. Antell. The change is permanent. Risks include bruising and swelling.

OVERALL FACE:

Over time, aging and sun exposure take their toll. Deep creases form between the nose and mouth, your jawline may sag and you may develop fat deposits around your neck. A face- lift can remove excess fat and tighten muscles and skin. The best candidates are those whose skin has some elasticity but who still have strong, well-defined bone structure.

The main options are the traditional operation and the short-scar face-lift, which involves an incision half as long as that used for the traditional procedure. It’s considered ponytail-friendly, since there’s no incision behind the ear. Dr. Antell typically performs short scar face- lifts along with a neck lift and facial resurfacing. In most such cases, Dr. Antell adds fat from a patient’s abdomen or thigh to the cheeks, which typically lose volume over the years. About half of the fat lasts forever, since it’s from the person’s own body, says the doctor. The procedure is performed under local anesthesia and mild sedation. Working through a very small incision from the inside of the ear canal to the base of the earlobe, a doc- tor tightens the deep layer of the face.

Recovery is shorter than for a traditional face-lift. A person can be back at work within a week to 10 days rather than the usual three to four weeks, says Dr. Antell. Possible complications include swelling and a small collection of blood forming, plus temporary numbness. The results last about seven to 10 years, depending on your sun exposure and aging. A traditional face-lift lasts about 10 to 15 years, says Dr. Antell.

SKIN TEXTURE:

A new procedure called needling helps smooth scars and wrinkles—and improves upper lip lines, says Dr. Antell. After you’re given a local anesthetic, a doctor takes an instrument that resembles a small paint roller with hundreds of needles on it and rolls it over the skin. “It’s like a lawn aerator,” he says. “It punctures the skin, stimulates collagen and causes skin tightening.” The procedure lasts about 15 minutes, and patients are advised to avoid the sun afterward for at least a week and until any redness subsides.

WHAT TO LOOK FOR:

Cosmetic procedures such as the injection of Botox to reduce wrinkles around the eyes or gel fibers to add fullness to the lips may be performed safely by a variety of practitioners. But if the service you seek requires surgery, it pays to find a doctor certified by the American Board of Plastic Surgery (ABPS), according to Valerie Jean Ablaza, M.D., president of the New Jersey Society of Plastic Surgeons and a member of Bergen Health & Life’s Health Advisory Board. You can check for board certification on the ABPS website at abplsurg.org. To learn more about the latest procedures, go to the American Society for Plastic Surgeons website at plasticsurgery.org.

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