Aging impacts our appearance and facial structure. Learn how the face is altered over time and the treatment options to help get back to a more youthful you.
Shelby Stockton: (00:00)
Welcome to the Texas ENT Audio Blog. I'm your host, Shelby Stockton. September is Healthy Aging month, so I sat down with facial plastic surgeon, Dr. Kent Davis. We talked about what affects aging and how the aging process is reflected on the face and neck. Dr. Davis also gives us some tips on things you can do right now to help prevent the signs of aging. Make sure you stay until the end because Dr. Davis educates us on some surgical and nonsurgical options to help us appear more youthful.
Shelby Stockton: (00:30)
If you'd like to stay on top of things when it comes to preventative aging care, this episode is for you.
Shelby Stockton: (00:35)
Dr. Davis, it's so nice to meet you.
Dr. Kent Davis: (00:38)
You too, Shelby.
Shelby Stockton: (00:40)
September is Healthy Aging month. So we'd like to focus on what patients can do to prepare and improve the appearance of the face and neck. So my first question for you Dr. Davis is, what causes the face and neck to age and around what age do we start to see these signs?
Dr. Kent Davis: (00:57)
Sure. Well, Shelby, in my facial plastic surgery practice, I see patients all the time that come in. One of their main complaints is when they look in the mirror, the reflection back looks much older than they feel, and that's very bothersome. We're very active people. We're on the go all the time. We're doing procedures on our knees and hips and things to keep us mobile, but we don't want to look old. And so fortunately there are things we can do to help with that. What affects aging? Well, there's genetics and lifestyle. Genetics, fortunate if we get those genes, we don't have much control over that. Lifestyle, I'll touch on that a little bit later.
Dr. Kent Davis: (01:44)
But you know what causes aging? Well, we have different layers of our face that all age, it's skin, it's fat, it's muscle, it's bone. On the surface is what we see most readily and the skin, we start to get loss of facial glands. And so we get less oil production and that causes less moisture. So our skin gets drier and rougher. We start to lose some of the collagen and elastin in our skin. And so then we start to form these wrinkles and we get sagging. We'll start to develop benign lesions on the skin that I call the barnacles of life that we're always addressing. That epidermis gets thinner. So our skin gets more fragile. It's easier to bruise as the blood vessels get thinner. And we start to get this blotchy pigmentation in the skin.
Dr. Kent Davis: (02:47)
But then beneath that we have the layer of fat and our fat pads get thinner as we age and they start to descend. So they get repositioned and that causes drooping and deeper lines like those nasolabial folds between our nose and the corner of our mouth, the jowling down lower along the jaw line. And then fat accumulation in the neck, the muscles underneath that. That repetitive movement of the muscles under our skin, it moves the surface of the skin. And so as we repeatedly do that, that skin gets constantly wrinkled. And over time, it's like a fabric, if you keep moving a fabric and wrinkling it, and wrinkling it, eventually you get like a wear line in that skin. We start off with these dynamic little lines that happen, but over time, then those lines, those wrinkles are permanent and stay there.
Dr. Kent Davis: (03:55)
And then beneath that we have the bone. More recently we've learned that actually we're having changes in the bone structure underneath as well. So we're getting resorption of bone and especially around the eye socket and around our brow and the prominent cheek bone area, and then around the jaw line. And so all these things combined to create the aging that we see when we look in the mirror. Now, we're addressing multiple of these different aspects of aging to try to reverse it.
Dr. Kent Davis: (04:29)
As far as what age do we start to see some of these changes? Typically, the beginning of it is usually in the mid-twenties and what I'll have patients coming in to comment to me about and complain about is they'll start to see those fine lines in the glabella area that we call the 11's, the little vertical lines between our brow. Some patients are starting to notice the horizontal wrinkles in the forehead. So we start entertaining some treatments for that, that I'll touch on later.
Dr. Kent Davis: (05:06)
And then as we get into the thirties, it advances and we'll start to see more of the folds between the nose and the corner of the mouth, the nasolabial folds. As we keep aging, we'll start to see in the forties, some changes happening in the eyelids, in the brow. And get into the fifties and sixties, and we start to see some that jaw line's not as crisp as it used to be. And the neck is fuller. When we're young, we have this what I call a triangle of youth, where we have some prominent, strong cheekbones and a more narrow defined jaw line. And as we age that triangle inverts, and so the face becomes more bottom heavy. And with sagging of the tissues, hollows under the eyes, and we lose that defined jaw line and neck line.
Shelby Stockton: (06:10)
Okay. I'm a little depressed.
Dr. Kent Davis: (06:15)
Don't be depressed because there's good news.
Shelby Stockton: (06:18)
Good. Okay. Here's my next question before you...
Dr. Kent Davis: (06:20)
I can help you.
Shelby Stockton: (06:21)
Please, can you give us some tips on how to prevent these signs of aging?
Dr. Kent Davis: (06:24)
Absolutely. So earlier I referred to genetics and lifestyle effects on aging. We don't have control over the genetics, but we do have control over lifestyle. One of the absolute main culprits for aging is sun exposure. Most of us are guilty, when we're young, we like that tanned bronze look. We just don't realize that what we're doing when we're really young is going to affect us later on. That ultraviolet light, it damages the skin and the elastin, the collagen. Sun damage, photo aging, that is a big contributor to early or premature aging of the skin. Smoking, horrible for the skin. So absolutely stop smoking, reduce alcohol consumption. Alcohol is very dehydrating for the skin.
Dr. Kent Davis: (07:31)
Some of those may be repetitive facial expressions that we make. Those can contribute to some wrinkles that we don't want. Healthy diet, reducing carbs and increase fruit and veggies, and their antioxidant effects can help with our aging skin. And then getting on a good skincare regimen. We carry Skinbetter, which is a pharmaceutical grade skincare line in our office. But there are lots of great skincare products out there, but everyone should be using a good gentle cleanser, moisturizer. Antioxidants like vitamin C, vitamin A's, like Retin-A that increase our cell turnover, eye creams, all these things are very helpful to ward off the effects of aging.
Shelby Stockton: (08:25)
Okay. So give up everything fun and get this skincare routine.
Dr. Kent Davis: (08:30)
Yes.
Shelby Stockton: (08:32)
Okay, got it. What about Botox? Is that a preventative...?
Dr. Kent Davis: (08:34)
Yeah, we have some wonderful non-surgical options to help patients and probably the most common of those is botulinum toxin. And there's several of those such as Botox that you just mentioned. What that does, it's injections that I perform in the office that relax the muscles where I inject them. And so they work great for those dynamic wrinkles. Especially those 11's that we see in the lower forehead between our eyebrows. We treat the forehead for those horizontal lines, treat around the eyes for the smile lines, crows feet.
Dr. Kent Davis: (09:21)
You can do it around the lips for some of those wrinkles that we get around the lips. We can inject in the neck to the platysma bands, which are muscle bands to help that improvement. And so that's probably one of the earliest things that patients will come to me about. So I'll see some patients in their twenties that are interested in botulinum toxin injections to help ward it off those wrinkles, because it actually can have a preventative effect too. Because if you're not wrinkling the skin with that movement, you're not creating those lines.
Dr. Kent Davis: (09:59)
Also, we have filler injections, which is also another wonderful non-surgical option. And those work great for adding some volume where we need it. So some of the most common areas for that are the nasolabial folds between the corner of the nose and the corner of the mouth. Adding some volume helps soften that area. The marionette lines that extend down from the corners of the mouth down toward the jaw, we can fill in that area. But there are other great areas too. So the temple area, as we age, we lose volume in the temple and we can fill that back with volume with fillers under the brow area. Lips wonderful. As we age our lips atrophy and they get smaller. And so we can create that more youthful lip appearance and with fillers.
Dr. Kent Davis: (10:56)
So those are probably two of the most common nonsurgical options. And then we get into skin resurfacing. I offer chemical peels, dermabrasion, laser skin resurfacing. All those are tools that help work on that surface of the skin. And help with the wrinkles and the blotchy pigmentation, the fine lines, texture of the skin. Those are great options.
Dr. Kent Davis: (11:27)
And then what I'm really excited about is now we have InMode's FaceTite and Morpheus machine. This is by far the best non-surgical option to replace a facelift. So facelifts still a gold standard. And I do lots of facelifts, but for those patients that are in-between, not quite ready for surgery like that, the FaceTite uses bipolar radio frequency energy. And basically in the office under local anesthetic and some breathing some nitrous, I can through some needle sticks, I have a probe that goes under the skin and one's on the surface. And basically we're heating the tissues with radio frequency energy. And we treat deep in the neck, along the jaw line, through the jowl area. We can also treat along the nasolabial folds to address that area. What this does, it dissolves some fat and it tightens the skin.
Dr. Kent Davis: (12:36)
I'll do a sandwich effect where I treat deep with the FaceTite and AccuTite. And then I come back with a different hand piece called the Morpheus Egg. It has microneedles that deploy through the skin. So now we're treating from the surface and the needles go into the skin and then they deploy radio frequency energy. And so we're heating that tissue more superficially. And we treat the entire face and neck with that.
Dr. Kent Davis: (13:06)
So commonly we'll do a treatment of the FaceTite, AccuTite, along with the Morpheus. And then we'll come back and repeat that more superficial Morpheus treatment, maybe two more times. And that's a great combination to really help rejuvenate the face in a non-surgical option. And we're seeing a lot of improvement in jaw lines, neck lines, tightening of the skin and overall improvement and complexion of the skin.
Shelby Stockton: (13:36)
Wow. I may have to make an appointment with you. Okay, last but not least. My question for you is what's a good age to start considering surgical procedures and what surgical procedures do you do there?
Dr. Kent Davis: (13:52)
Absolutely. In my facial plastic practice, I offer a wide spectrum of surgical options. And some of those will start as early as five years old for kids. Now that's not going to be aging, but I do autoplasty surgery to basically for children with prominent protruding ears and reshaping those and bringing those back. And that's very common in the young population. As I get up into the 15, 16-year-old range with girls and 17, 18-year-old range with guys, I'm doing a lot of rhinoplasty surgery to cosmetically reshape the nose and improve that appearance. And then as I get into the facial aging procedures, I'd say probably it's mostly around the forties I'll start seeing patients coming in that don't like the appearance of the eyelids.
Dr. Kent Davis: (14:52)
Those upper eyelids start to get a little heavy, that eyelid skin starting to fold down and maybe block the eyelashes. And they're having difficulty applying eye makeup and keeping that youthful look. And so I'll do blepharoplasty surgery for that, with the upper eyelid. And then in that lower eyelid, we start to see some of that fullness that happens that we get some protrusion of some fat in that lower eyelid. And we get a hollow along the rim of the eye socket that we call a tear trough deformity. And so I'll do a lower eyelid blepharoplasty for those patients. And I can remove some of that fat and transfer some of that fat across that infraorbital rim to help smooth out that tear trough. And that's a wonderful option for treating that whole eye area.
Dr. Kent Davis: (15:49)
And then as patients keep aging from there, then I'll start to see them coming in complaining about the brow position or that mid-face is starting to descend. I can perform an endoscopic brow lift and an endoscopic mid-face lift. And with that, I just have hidden incisions behind the hair where I can come down endoscopically, free up the tissues of the forehead and the mid-face and lift those back up where they used to be and suspend those. That works wonderfully from a minimally invasive incision approach.
Dr. Kent Davis: (16:31)
And then I'd say, as we get a little older into that mid-fifties on up, a lot of the patients are complaining more about that lower face and the neck and the jowling. And so what works wonderfully, there is facelift. And there's multiple options for that. I can do a sub-SMAS facelift or deep plane facelift, and lift those tissues back up. And it's the gold standard. Nothing will recreate that crisp jaw line and that tight neck line like doing a lift. And patients are often nervous about that. It sounds kind of scary. They don't like the idea of a facelift, but the reality is the recovery from that is not that bad. There's very little pain. Patients frequently take their pain medicine the first night or two. And that's it. It is just mostly dealing with some swelling and bruising.And you get beyond that, and patients are quickly back to work and back to their normal lifestyle.
Dr. Kent Davis: (17:39)
Some of the interesting things with facial aging, I'll see patients coming in later, sixties, seventies, and they don't like that their ear lobes have continued to elongate. And so now they have these pendulous earlobes. So I'm doing earlobe reductions in the office for that. And it's just fun. There's just so many options out there nowadays to help people with their aging.
Shelby Stockton: (18:12)
Honestly, I could sit here and listen to you talk about this for hours. It's so interesting. But I know that you have things to do. But thank you so much for talking to us about aging of the face and neck. It's fascinating.
Dr. Kent Davis: (18:25)
Well, thank you for having me.
