Are You A Candidate?

Facial Rejuvenation: How Early is Too Early?

Andrew A. Afshar, MD, DDS

I am often asked by prospective patients about the timing of various surgical and non-surgical treatments for a more youthful appearance. They would like to know for instance, if “twenty-something” is too young for Botox, or if “thirty-something” is too young for a facelift.

The fact is that there is no simple answer to this complex question. Variables such as nutrition, exercise, tobacco and alcohol use, skin care, sun protection, and last but certainly not least, genetics all play integral roles in how we age. Ultimately, the combination of these factors determines the rate and the extent to which changes associated with aging take place. Given this variability, it becomes obvious that this “ideal age” is different from person to person.

There is also the consideration of prevention versus treatment. As the adage goes, “an ounce of prevention is worth a pound of cure.” Routine skin care and sun protection are obvious examples of this proverb. One is never too young to protect himself or herself from the sun and the wind with hats, sunglasses, and skin products high in SPF. Such habits can hold future surgical procedures at bay by promoting and maintaining more youthful skin.

How about more invasive treatments? Let’s take for example, Botox administration on a “twenty-something” patient. Treating such a patient who may not yet have any visible signs of skin deterioration is actually a viable strategy in fighting off the most basic and elusive signs of aging, facial lines and wrinkles. Botox works by diminishing the actions of the underlying muscles which are responsible for forming the lines and wrinkles in the first place. Although there is no doubt that Botox administration later in life is of tremendous benefit in smoothing the lines and wrinkles which have already formed, the best scenario is to keep them from forming in the first place. There will then be less existing signs of aging to deal with in the future.

Let us now consider surgical treatment. Traditional procedures performed for face and neck rejuvenation include eyelid surgery (blepharoplasty), brow lift, and face and neck lift (cervicofacial rhytidectomy). The common goal of these procedures is to enhance the patient’s facial features by removing excess skin, muscle, and fat. The goal is to achieve a natural, rejuvenated appearance with minimized “sag” of facial soft tissues.

There is interplay between genetic and lifestyle factors in determining when such procedures may be deemed beneficial. For instance, a patient who already has a familial predisposition for “hooding” or skin redundancy of the upper eyelids may be a candidate for blepharoplasty at a younger age than a patient without such a trait. Excessive and unprotected sun exposure would of course further hasten this need.

Another example of variation in timing is when a face or neck lift would be an appropriate next step in a cosmetic patient. Familial traits such as skin laxity (looseness) and excessive neck fat accumulation are factors which would be addressed with a face and neck lift. They of course manifest at differing ages from person to person. As always, environmental exposure to sunlight, tobacco, and alcohol are other variables which affect the general quality of skin. A “thirty-something” patient may indeed on occasion be a candidate for a facelift. This patient demographic will usually require only skin tightening since the underlying muscles are typically still resilient. Of course lifestyle modification and skin care should be emphasized to such a patient, whether they are surgically treated or not.

In summary, the original question has many different answers depending on the patient’s familial traits, daily habits, and most importantly, chief complaint. The strategies of prevention, treatment, and ultimately, maintenance of results are appropriate at different ages. Active discussion during a consultation will shed light on the strategies available for a patient, since every patient is truly unique.