The yearning for a fresher, younger appearance is alive and well in Central Jersey, whether people want to stay as visually appealing as their younger colleagues or to elicit the desired response from the “mirror on the wall.” For area plastic surgeons, new products are fueling a trend toward less-invasive procedures, often among a much younger cohort.
Princeton plastic surgeon Nicole Schrader says she is seeing patients in their 30s and 40s who want to do something that that can offer 5 to 10 percent improvement and is “minor invasive,” like skin care products, Botox, fillers, and treatments of skin changes with laser or other devices.
“People are looking for a treatment that doesn’t involve cutting or anesthesia,” Schrader says.
Older patients are also taking advantage of products like Botox or fillers. One of Schrader’s patients, still working in her 80s, comes regularly for treatments. She tells Schrader that just like she needs to get her hair done, she needs her skin to look good.
Years ago, says Dr. Robert Glasgold of the Glasgold Group in Highland Park, “there weren’t these intermediate steps that we could do with different injectables and other things; today it isn’t just the heavy equipment of facelifts or deep chemical peels.”
Injectables on the market address wrinkles and facial changes as well as unwanted fat in the neck. Both Botox and Dysport relax muscles that cause frown lines, crow’s feet and forehead lines. Thinner fillers like Restylane and Juvederm can fill in small lines like those around the lips.
The availability of thicker fillers like like Voluma and Restalyn Lift have created another trend, Glasgold says: the use of injectables to restore volume to the face. “When you are thinking of hollows that cause shadows under the eyes, that’s not just fat loss, it is also bony changes that occur in the face,” he says. Achieving a more natural, youthful appearance can be a matter of adding volume in certain areas, rather than simply pulling things tighter.”
If patients have good skin tone, a series of injections with a new product, Kybella, can dissolve fat under the chin. The advantage of Kybella over liposuction, Glasgold says, is that people come in and have injections, get some swelling, go home, and wait a month. Usually patients need at least two sessions to complete the treatment.
Schrader also prescribes daily topical treatments that help skin cells turn over, provide better texture, and prevent aging of the skin. It doesn’t change the skin overnight, Schrader says, but does so with regular use. “Patients come in their 30s or late 20s who want to do something now to prevent aging changes,” she says.
Even though the improvements from injectibles and other noninvasive procedures are relatively short term solutions, they can probably buy people in their 40s or older some 10 years of additional youthfulness. Schrader says. Comparing this to the situation to the 1980s and 90s, when surgery was often the choice, she explains, “Instead of a facelift, patients want to do good skin care, fillers, a little Botox, little laser for rejuvenation.” Facelifts haven’t become a thing of the past, however — far from it.
A patient’s decision to have a facelift as opposed to an alternative procedure depends, among other things, on the goals of the individual and the person’s underlying facial structure,” Glasgold says. Younger individuals with less jowl volume can potentially get very good jawline restoration with the use of injectable fillers. As the jowl becomes heavier and skin looser, a facelift becomes a much more effective option.
Plastic surgeons are also using liposuction and CoolSculpting to reduce fat. CoolSculpting, a newer option, works through a freezing of the fat, which causes 20 to 25 percent of the fat cells to die off in the ensuing month or two.
“For people who have love handles, bra fat, or fullness in the flanks, it is a technique that can eliminate it without surgery or down time,” says Dr. Thomas A. Leach of the Princeton Center for Plastic Surgery. He says it has been available for two or three years in Europe and seems to have no negative consequences.
Although CoolSculpting offers only about 10 percent improvement, it doesn’t require much aftercare and can be done at lunchtime, albeit with some bruising and discomfort. On the other hand, liposuction, which can remove more fat, requires either a topical or a complete anesthetic, must be done in a surgical facility, and usually requires patients to take off from work for a couple of days.
In a day and age when patients are learning about new products and procedures for “improving” their faces and bodies via mass media or the Internet, they often come to a plastic surgeon’s office with very specific ideas about what treatment they want. But this has a serious downside—self-diagnosing patients demanding treatments that are inappropriate for them. Leach says, “I end up turning a fair amount of people down because what they are asking for doesn’t make sense … and is not the right thing for them.”
Leach recalls one prospective patient who came to him seeking liposuction, but had too much extra skin for the procedure to be effective. He declined to do the work, so the patient got the procedure done by another practitioner, only to return to Leach after a botched job asking for help.
In another case, Leach saw a patient with a terrible result and a complication from Botox that had been injected by her gynecologist. “Every time these relatively simple procedures [generate a story in the media], it is usually because somebody who was dramatically unqualified provided the service,” he says.
Leach says most of his patients visit him because “they don’t like what they see when they look in the mirror.” Sometimes a divorce or a new job has them looking at themselves differently. “Or young kids after college always bothered by their nose, who have not taken a picture of themselves for the last 10 years and are moving out of their parents’ house,” he says.
Schrader adds that the changes people seek need not be dramatic. “I see my patients at McCaffrey’s and Whole Foods. They feel confident, and they don’t look overdone, like they had a major change,” Schrader says. “The trend is to have more natural and more minimal results.”
Dr. Nicole Schrader Facial Plastic and Reconstructive Surgery, 615 Executive Drive, Princeton; princetonface.com. The Princeton Center for Plastic Surgery, 932 State Road, Princeton; princetonsurgery.com. Glasgold Group Plastic Surgery, 31 River Road, Highland Park; glasgoldgroup.com.
See also: Dr. Eugenie Brunner, 256 Bunn Drive Suite 4, Princeton, brunnermd.com; and Dr. Jill Hazen, Hazen Aesthetic Institute, 10 Forrestal Road South Suite 104, hazenplasticsurgery.com.
Michele Alperin is a free-lance writer living in Princeton.
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