Facial features lose their definition and contour as we age. Although unique to each individual, it’s important to understand the process when deciding on a treatment option to address your concerns.
Shelby Stockton: (00:00)
Welcome to the South Florida ENT Audio blog. I'm your host, Shelby Stockton. September is healthy aging month. So I sat down with otolaryngologist and fellowship trained facial plastic surgeon, Dr. Jennifer Harb. We had a fascinating conversation about what causes the face and neck to age, and she gives us some tips on things that you can do today to help prevent the signs of aging. Dr. Harb discusses different surgical procedures, and gives a short lesson on the difference between a mini face lift and a full face lift. I was enthralled with our conversation. So if you're intrigued with preventative aging care, this episode is for you.
Shelby Stockton: (00:35)
Hi, Dr. Harb, how are you today?
Dr. Jennifer Harb: (00:37)
Hi, I'm great. How are you?
Shelby Stockton: (00:39)
I'm great. And I'm really excited to talk to you today because it's September is healthy aging month, and we want to focus on what patients can do to prepare and improve the appearance of the aging face and neck. So my first official question for you is what causes the face and neck to age, and at what age do the signs start to become more apparent?
Dr. Jennifer Harb: (01:02)
I would say it varies for everyone. Everyone's a little bit different, but there are changes that happen to the face on every level. So from a skin, very superficial level, effects from the sun and quality of the skin and wrinkles, but also deeper than the skin. So as we age, the amount of fat and the location of the fat in our face changes, also the bone structure underneath can change as well.
Dr. Jennifer Harb: (01:32)
So as perhaps we lose some teeth or strong dentition, our jaw lines become a little more thinner. The medical word would be atrophic. Our cheekbones can also diminish as we age as well. Not only just because of fat, but also the bone underneath. And so it's really at all levels of our face and neck that we do experience changes as we age. And like I said, this can vary for people. Some people may not experience a lot of these changes until they're late 40s, 50s, 60s. Some may actually experience a lot of those changes say late 20s, early 30s. So it really is very patient dependent and lifestyle dependent.
Shelby Stockton: (02:16)
And genetic dependent, I guess, as well.
Dr. Jennifer Harb: (02:18)
Oh, absolutely.
Shelby Stockton: (02:20)
So can you give us some tips on how to prevent the signs of aging?
Dr. Jennifer Harb: (02:25)
Absolutely. I think there's some very basic things that everyone can just incorporate into their routine today. Some of those things would be great skin care. We really got to start from the outside going in. Some of those things would be incorporating a moisturizer that has a sunscreen in it. That's a very easy, every day sort of thing that we can do. A lot of moisturizers already have sunscreens incorporated in them. So that's a nice, easy way to get started.
Dr. Jennifer Harb: (02:56)
Another thing that I like, for patients even in their 20s, 30s, starting really early is starting them on a Tretinoin. It's a cream that you put on nightly and it can be very effective over the long term in reducing fine lines, wrinkles, evening the complexion of the skin. So I think that's great. Also a cream that has vitamin C in it, and vitamin C at a high enough concentration where it's actually going to make a difference. So there's a lot of just very simple things that you can just incorporate into your routine, off the bat, that'll help. What was the other part of the question?
Shelby Stockton: (03:34)
Oh, I do have a question about Tretinoin if you don't mind. Is that a retinol or a retinoid? Is that what that cream is?
Dr. Jennifer Harb: (03:42)
Yeah, it's part of that family and it's very important to distinguish because there's also Acutane, which is isoretinol, which is a different compound altogether. So the Tretinoins come in different percentages, some of which are prescription level and others that are just over the counter level. And so even some of the lower concentrations can be bought over the counter or through some of your favorite skincare websites, but some of them are prescription grade. And obviously, as you go up in those higher percentages, those are those prescription grade ones, and they tend to be more aggressive on your skin. So that's something that I like to discuss with patients when they're starting a regimen like that, what to expect, what level is appropriate for them to start with and when they can start to see results and what those results might look like.
Shelby Stockton: (04:38)
So for another preventative care, Botox is all the rage. So could you explain what that means? What it does?
Dr. Jennifer Harb: (04:48)
Sure. So preventative Botox is an interesting thing, and I get asked about this a lot. So the mechanism of Botox is basically that you are preventing muscles that are underneath your skin, obviously from contracting. And so when we inject it say into the forehead, the idea is that the muscle underneath the skin will not contract and when it contracts, form those wrinkles. And so when we prevent that from happening, we prevent the skin from wrinkling and voila, no more wrinkles on the forehead.
Dr. Jennifer Harb: (05:22)
Preventative Botox is the idea that if you do this before you actually have wrinkles forming, then you can stave off the formation of wrinkles in general. I do agree with that. I think for the right patient, I think that makes a lot of sense. Obviously, it's a form of aging preventative medicine. The one thing I will caution against is that if you start Botox at a young age and you do it frequently at high doses, we can develop a resistance to it. It's not to say that you will. It's kind of a rare occurrence and there are other Botox variants that we can inject to get around this. But just something to think about. It is part of the pros and cons discussion as with any sort of intervention.
Shelby Stockton: (06:12)
Okay. That's interesting. So my final question for you is what is a good age to consider surgical procedures and what are those procedures?
Dr. Jennifer Harb: (06:21)
There's a lot of different surgical procedures. It's an interesting question, because again, everyone ages at different rates and has different concerns. So it's a little hard to say, but there's a whole myriad of procedure. So basically, we always think of facelifts. You can think of eyelid surgery. We can think of lip lifts. We can think of neck lifts, brow lifts, all of these things.
Dr. Jennifer Harb: (06:49)
So if we think of the face and neck as one whole cohesive structure, as it is, gravity will affect and aging will affect all this similarly. So the face will begin to age and descend, the neck will also descend. So you may get like a turkey neck or the upper lip will also begin to descend. And that space between your nose and your upper lip will elongate. That can also lead to an overall aged appearance. The brows, which normally sit on this bone right above our eyelids will also descend and that just creates an overall appearance of aging.
Dr. Jennifer Harb: (07:27)
And so when we think about addressing some of these things, you want to pinpoint what is causing the face to look older. And so that may mean that you need a couple of these different procedures, based on just your specific anatomy. A lot of people, their brows are in the same place that they've been for many, many years, and they don't need a procedure on their brows, but they've noticed that their cheeks have descended and that they have a turkey neck. And so it's very, very patient specific. Even in terms of what age to even start to consider these procedures. I always say, if you want come for a consultation, you are not necessarily signing up for surgery. You are not writing your name on any line, but it's a nice time to have a discussion with your provider to see where things are going. What might help you at this stage, what to think about, things to incorporate into your regimen.
Shelby Stockton: (08:26)
Can I ask you a question about mini facelifts. Because a lot of people I know who are starting to get in their 50s are talking about these mini facelifts. What is that compared to a full on facelift?
Dr. Jennifer Harb: (08:36)
So there's lots of different types of facelifts. And that's a great question. So basically when we're doing a facelift, like I mentioned before, there's all these different layers to the face. And so you have your skin layer, you have underneath your skin layer, you have a layer called SMAS, which basically is this tissue that incorporates many of the muscles of our face.
Dr. Jennifer Harb: (09:01)
So when we think of a deep lain or more aggressive facelift, we are lifting the SMAS up and re-suspending it to a place that it previously was at maybe when we were younger. And then when we do that, the skin goes along with it. So that will give us a more aggressive lift. Some people ask about these mini face lifts, and that can include something that is maybe just skin based where we're not going into that deep plain and lifting the SMAS with it. Or it could include a little bit of SMAS lift where we're not really dissecting all the way down to the center of the face. We're staying more on the lateral edges of the face and pulling it up that way.
Dr. Jennifer Harb: (09:51)
Again, these procedures are good for certain types of problems, different types of aging that patients may present with. But as with almost anything, the less aggressive a procedure, the perhaps less dramatic the results will be. And sometimes with some of these procedures that are not like the mini facelift that are not as aggressive, you may see recurrent effects of aging, 5 to 10 years down the line. And at that point you may want a more aggressive facelift. So again, it's very patient specific, but in general, the more aggressive you go, the more dramatic your results will be. So you have to know or have a discussion with your provider about what is appropriate for you.
Shelby Stockton: (10:40)
That is so fascinating. SMAS, what a great word.
Dr. Jennifer Harb: (10:45)
Yeah.
Shelby Stockton: (10:46)
It almost seems like it's cartoonish, but that's so cool.
Dr. Jennifer Harb: (10:49)
Yeah.
Shelby Stockton: (10:50)
Dr. Harb, I could talk to you all day about this. This is one of those things I'm obsessed with, but unfortunately, I have to let you go because you do have a life, but thank you so much for spending time talking to us about all of this.
Dr. Jennifer Harb: (11:01)
Absolutely. Thank you.
