“Nature gives you your face at twenty. Life shapes your face at thirty. But the face you have at fifty is the face you have earned.”

Coco Chanel

Yesterday, while performing a minor procedure, I was asked by the patient why so many older women in New York City seem to have overly stretched faces, or faces which have been filled beyond capacity.  I had to agree that unfortunately this has been the recent trend on the Upper East Side when it comes to facial rejuvenation.

I recently examined photos of women of all ages to determine for myself what really creates an impression of a youthful face, and I found three main factors that we lose as we age: 1) volume, 2) tone, and 3) texture.  The face of a young woman has volume in the mid-face, with a round cheek and smooth contours.   Her skin is firm, but never tight, and the skin tone is even.  As we age, we lose much of this volume, with atrophy of the facial fat.  The skin loses its elasticity and falls, and we are often plagued with variations in skin pigmentation.  To address these issues, plastic surgeons have traditionally performed facelifts, in which excess skin is excised and the underlying structures are re-suspended.  Volume can be added through the use of fillers, including fat and hyaluronic acid (e.g., Juvederm®).  However, if the approach to facial rejuvenation stops here, the result is a face which has been stretched and filled, which, if overdone, distorts the natural features; we’ve all seen women with stretched out or overly plump lips, which, in my opinion, is never attractive.  In addition, if the tone and texture of the face have not been addressed, the goal of facial rejuvenation will have fallen short.

The majority of patients in my practice neither need nor want a facelift.  They are generally looking for a non-invasive method of facial rejuvenation.  For these patients, to restore volume, tone, and texture, a multi-factorial approach is needed.  Depending upon a patient’s anatomy, I may begin with judicious use of fillers for the mid-face, including Voluma® and Juvederm®, while fine lines are addressed with Botox®.  Skin tone and texture are then addressed by my very skilled aesthetician, Michelle Calabrese.  Michelle uses a combination of modalities, including Pelleve®, microcurrent, microdermabrasion, and chemical peels.

Pelleve® is a radio-frequency based treatment which delivers energy to the dermal tissue. The heat emitted induces collagen denaturation and subsequent contraction, which creates skin tightening.  An immediate result is seen, which is typically sustained following three treatments spaced one month apart.  Microcurrent uses fine electrodes placed on the surface of the skin.  Low electrical impulses are delivered to the face to tone the muscles and provide a temporary “micro-lift”.  Microdermabrasion is performed with the DermaSweep® MD system, which contains fine bristles of varying grades to gently and effectively remove dead skin cells from the surface of the face.  Depending upon the skin’s needs, selected infusions of vitamin C, hyaluronic acid, or kojic acid may be added to the treatment for direct delivery to the epidermis and dermis.  For chemical peels, we prefer the PCA Skin® line which consists of blended peels which use both natural actives and modern science to deliver gentle yet highly effective results for all skin types.

By approaching facial rejuvenation in a gentle and problem-oriented fashion, it is my hope that we can create a new trend, which is a look of a refreshed, vibrant face which maintains its inherent beauty and youth.