Dr. Barbour’s Answer: First of all, “need” is a relative word when it comes to quality of life issues. It’s really about what you want and your priorities in life. Also, remember that the best cure is always prevention, and sometimes prevention can take a whopping amount of discipline. But what does one “need” to have an appearance that pleases them and the people around them? Absolutely, it’s a look of health, and the best way to have that is to be healthy!
The relatively free things are good nutrition with as close to a healthy vegetarian diet as you can comfortably get. A great book to read if you’re not too sensitive to some humorously liberal language is “Skinny Bitch” by Rory Freedman and Kim Barnouin. The second thing is to have some kind of exercise program that includes both resistance and aerobic exercise. Always check with your doctor if you have any health conditions. As we age, exercise becomes more and more a factor for longevity and quality of life. Looks-wise, it’s great for your circulation, for your figure, and ultimately for your self-confidence. All of us, no matter how busy we are, can make time for it. Trust me on this. Where there’s a will, there’s a way. Self-discipline. No excuses. Do it.
Now that the proselytizing is out of the way, what’s next? As I’ve said elsewhere on the website, the foundation of external beauty is healthy skin. Numero uno is avoiding sun damage and I’ve also covered that. Just about everybody should be on some form of a topical retinoid. Your best bet is to have one prescribed by your doctor as she or he will be there for you to make sure it’s working and not causing undue irritation to the skin. Another relatively inexpensive form of upkeep is to have a good, deep-cleansing facial by a licensed aesthetician every four to six weeks. A good aesthetician will help keep your skin healthy and recommend a simple skincare regimen that is optimal for you. With professional recommendations you have someone there for you and what you spend on their services is probably less than what you’d end up wasting on products that may not be for you or may not deliver the results they claim.
Regarding procedures, many of my younger patients or people that have never had cosmetic work done in the past will start with Dysport or BoTox to relax the muscles that make the face look tired or angry. When these muscles are properly treated, some of the happy muscles that seem to lift the face a bit are actually allowed to work more efficiently.
The best way to proceed is to contact a doctor whom you feel you can trust and let them evaluate and guide you.
Dr. Barbour’s Answer: As with the face itself, there are both genetic and lifestyle choice components to how the neck ages and how rapidly it ages. There are three changes in the neck that seem to bother people the most. Let’s take them one-by-one:
1. The most common complaint about the neck is the quality of the skin. Usually, by the time people are upset about it, it has lost a lot of its elasticity and is looking crepey, especially at the base of the throat. Another common problem is the “necklace lines” that run horizontally. You may be relieved to know that contrary to what may seem apparent when we pull up on the neck skin in the bathroom mirror, the best way to treat this problem is not surgery, but to actually improve the quality of the skin. First of all, and forgive me for harping, sun damage (need we even mention smoking anymore?) is the most common cause of aging of the skin, so remember to protect your neck the way we know you so carefully protect your face. It’s never too late to start! P.S. Don’t forget those nasty UVA rays that come in through the car windows.
For the damage that’s already there, retinoids (some incarnation of Retin-A-type products) are invaluable, although they need to be used more sparingly on the neck than on the face. High quality topicals with antioxidants are also helpful. Again – never too late to start. A good aesthetician will have a variety of peels from which to choose and some of these can at least help the pigmentation and some of the texture. To tighten and shrink the skin and the underlying connective tissue, we use Pellevê, a radiofrequency-based treatment that my patients love. Variable success has been demonstrated with fractionated lasers. Both the radiofrequency and laser devices are technique-dependent, so those treatments require a good machine and a good practitioner.
2. The second most common problem is the bands or “turkey wattles” at the center of the neck. These are the edges of a muscle that runs vertically in the neck and up over the jawbone. As we age, those edges, rather than sinking nicely into the angle of the neck, tend to contract and lift away from the neck. Mostly we want our muscles to be nice and taut, but in this case we want the muscle relaxed so it can have the extra length to form more of an angle from under the chin down the length of the neck.
So while we don’t ever want to pull or stretch the skin, we want to stretch and relax that muscle beneath the skin. A good preventive and maintenance exercise for this is the “lion pose” if you practice yoga. Another excellent way to relax the muscle is to extend your head back and jut your jaw out as far as you can (F.Y.I. This is also a great way to clear your ears if you’re descending in an airplane.)
If the bands really are starting to show, we can relax the muscle by injecting it with some Dysport or BoTox. These muscle relaxers can also be used in many individuals to make the jaw look more defined. This all may sound a bit counterintuitive, but it does make sense anatomically! The nice thing is that Dysport and BoTox tend to last longer in the neck than they do in the face. Also, once the muscle edges are weakened over a period of time with repeated injections, the injections last longer as well.
Once those bands are prominent, I’m afraid we have to consider surgery to smooth out the neck.
3. Some people are bothered by a fat pad under the chin. Unfortunately, our skulls shrink as we age. (This isn’t about osteoporosis; it’s more about just having birthdays.) The little pad of fat may be minimally bothersome in youth, but as we age, we can accumulate additional fat there, and the loss of bone support in the lower face (the jawbone and chin) can make the fat look more prominent. Sometimes we can delay removing the fat surgically by using fillers to strengthen the jaw line or add dimension to the chin. This is literally sculpting the contour of the face from the inside out, and if done well, it can make an amazing difference.
Dr. Barbour’s Answer: The reason you can't seem to get away from hearing about sunscreen is because most of the aging changes in the skin are due to sun damage, not to mention even worse punishments like skin cancer. Let's get a few things out of the way about sunscreen and then I'll address some other ways to prevent aging of the face that you may never have known before.
Healthy skin is the very foundation of beauty. Your nose can be too big, your chin too small and your eyes unimpressive, but if the skin is smooth and luminous with health, you're going to look and feel really good. That makes you more self-confident and there's nothing as attractive as self-confidence!
There is a plethora of good sunscreens available, both chemical (containing, for instance parsol 1789 or mexoryl) and physical ( nonchemical, and containing zinc oxide or titanium dioxide). Basically, the chemical screens work by absorbing the rays and the physical ones work by reflecting them back away from you. It is important to remember that if you're actually going to be in the sun for more than about thirty minutes reapplication is important. Also, it's better to pat it on rather than rubbing it in. We carry a sunscreen that I can't live without, called Reflect 30 Natural Sunscreen, by Cosmedix – it's titanium dioxide-based and mists on from a green-friendly mechanical aerosol spray. You mist it on, pat it a little, and it disappears. Two added benefits are that it also contains potent antioxidants and best of all, you can apply it right over your make-up and it absolutely doesn't disturb a thing! If anything, it makes the face look fresher and a little more as though it's being seen through a softer light. I think this sunscreen is the best thing since blueberry pancakes.
Now, other ways to avoid sun damage:
· Remember that those UVA rays come right through windows and while they won't tan you, they will silently destroy your skin. Be aware of this especially when you're driving. Every single day I see people in their cars with the sun on their faces and necks as it streams in from the side. Almost always, I can tell if a woman is usually the passenger or the driver because of the additional damage on the left side of the face.
· There are protective umbrellas available that will block about 98% of the sun's rays and there are some really cute hats with usually about a 55 SPF as well. If you absolutely can't deal with hat hair, the bumbershoot is the way to go. I have a great one from Coolibar that I love. Do I feel a little dorky? Not so much anymore, and hey, if everybody used one it would be the norm, wouldn't it? Believe me, the good skin is worth it and if someone wants to be cute and says, "Is it raining?" I just answer, "No, but it's sunning really hard". A plus, especially here in Florida, is that when you're using it, you're always walking in the shade so you stay cooler. And lastly, it of course protects your hair and especially the hair color you may have paid your hard earned pennies to have.
· Look for a make-up primer that has an SPF attached to it. The goal at my office is to get my patients' skin so gorgeous that they don't even want to wear foundation, except maybe a little mineral make-up powder down the center of the face. (However, having said that, those powders and indeed most foundation make-up will add to your sun protection). What is important to know is that a make-up primer can be used on its own and will just make your otherwise bare skin look more poreless and more as though it's being seen through a diffused light. We carry one called "Absence" by Jane Iredale that has an SPF of 20 right off the bat, even before the sunscreen goes on.
· Lastly, does all this sound like a pain in the neck? It's just about forming new habits and then waiting for the compliments. And for those of you under 35 years old, believe me when I tell you that 40 years from now, and that time will come, you will be soooo glad that you had the foresight to know that you will absolutely care about how you look then, that you can look gorgeous when you're older, and that the best cure is prevention. If you need proof about what I've just said, Google the 80 year old model, Carmen Del Orifice. What an inspiration she is!
Chapped lips are annoying at best and painful at their worst. Just as with the skin on your face, lips respond well to gentle exfoliation and liberal moisturizing once a week.
If you have one of those mechanical spinning toothbrushes, after you’ve rinsed off all the toothpaste, use the brush lightly on your lips. Immediately afterwards, use a good lip moisturizer and keep it on overnight. For the best results, our Jane Iredale Sugar and Butter is a perfect way to perform both tasks (besides the Sugar part tastes delicious!).
In between exfoliations, always apply a lip balm at night. One we love is Lip Drink, also by Jane Iredale. .
And when you’re ready to really restore the lips, smooth the wrinkles or amp up what nature gave you to where you’ve always wanted your lips to be, let’s talk!
The two columns extending from the base of your nose to the cupid’s bow tend to flatten as we age -- a tiny thing that just subconsciously “reads tired”.
Take a very pale beige or white eyeshadow with just a hint of shimmer (Jane Iredale’s Opal Crush is perfect) and use a small shading brush which you will touch just lightly to the shadow. Place a faint line on the crests of the columns and then run it just above where you’ll place your lip liner.
This has to be done very subtly, so you may want to take a fingertip and pat it a little to blend. Sit back and look – immediately there’s a perky little pout and the upper lip looks more elevated! (Jill or I can show you how to do this too.)
I’ll have another tip for you on October 20th!
...use lip liner to crisp up the lip line and make sure you keep the lip liner color natural.
Jane Iredale’s “Spice” is a great, almost universal shade, and despite its name, it’s not orangey at all. Keep a slightly softened point on the pencil. Create the line along the outer edge of the roll of the lip centrally and drop it a bit at the corners unless you need to create a little “smile” at the upper lip (Jill, our medical aesthetician, or I can show you how to do that, if you’d like).
The reason for this is that a young lip is high and narrow, while an old lip is collapsed and wide. Never extend the line out over the flat part of the lip, beyond the roll, or it begins to look clownish. Also, keep it out of the corners for the same reason, plus it’s aging.
Make sure your lip liner and lipstick blend seamlessly into each other so there’s no discernible line. Then take a tiny bit of shimmer and place it on either side of the center of the lower lip and smack in the center of the top lip. Blend any edges. The shimmer will do what a highlight on a painting does – it will bring it forward and give a lovely little pout to the lip while softening the color a bit.
Stay tuned. I’ll have another tip for you on October 14th!
Beautiful Lips always look lusciously soft and are harmonious with the rest of the face.
Time and time again, patients will say, “I don’t want to have lips like [so-and-so movie star]” or “those big lips” and my answer is invariably, “If you see lips that look as though they couldn’t occur in nature, they’re not out of this office”. The idea is to have a face that you’re proud of, and part of that face is your lips.
Furthermore, particularly as we age, more and more attention needs to be given to the area around the lips as well.
If you’re still on the fence about having this area treated professionally, I have some great tips for you that will help make the most of your lips all by yourself.
Look for the next entry October 6th.
Oculofacial Plastic Surgeon, Sarasota, Florida
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