The Art of Looking Younger

Is it true what they say—that people here are more beautiful and more beauty-conscious than average? "I’d definitely say so," says Naples plastic surgeon Dr. Mark Prysi. "Look around: Even the medians here are beautiful." But it’s not all about vanity, and it’s not all about women. Prysi reports an increase in his male clientele, particularly in certain professions. "About 15 percent of my patients are men whose careers depend on avoiding the stigma of a tired look," he says. "A real estate developer, for example, doesn’t want his clients asking, ‘Who’s really going to do this work?’" Fort Myers facial plastic surgeon Dr. Patrick Flaharty agrees: "Some eyelid wrinkling is acceptable, as it adds distinction to a man’s look, but the eyes are the first to reflect fatigue, and that can adversely affect his business."

Growing Old Gracefully ... Not
Southwest Floridians aren’t asking to be made over into Brad Pitt and Angelina Jolie. We simply want to look fresher and better, Prysi says—more like our younger selves. And we’re no longer waiting until we’re 60, 50 or even 40 to be proactive about it. With minimal incisions, amazing new surgical techniques and miraculous products, those long weeks in hiding while scars heal are history. Nearly instant perfection is ours.

Consider those injections we’ve gladly suffered every few months to plump up our lips or make telltale wrinkles disappear. FDA-approved for barely three years now, the current formulations of hyaluronic fillers such as Restylane, Radiesse and the newest media darling, Juvederm, are getting some serious competition. These smooth gels are miraculous, replacing the original bovine collagen products, which often caused lumps and bruising.

But collagen is back, Flaharty tells us, with the wrinkles ironed out, so to speak. ArteFill, the first and only FDA-approved nonresorbable filler, is twice the price of the hyaluronics, which range from $750 to $950 for an average 8 cc treatment, but a one- or two-session treatment will last for years. ArteFill is especially promising as a second line of defense, for areas with really deep creases, he says. As with all collagen, it does carry a risk of allergic reaction, so a patch test is necessary.

And the news gets better. According to Naples dermatologist Cynthia Strohmeyer, long-lasting Botox is not far behind. Currently, a typical injection of Botox-Cosmetic to relax the muscles that cause severe frown lines lasts from three to six months. The next generation of Botox, currently under review by the FDA, is expected to last five years or more.

Impressive enough, but these things pale against state-of-the-art facelifts. Too bad certain film stars didn’t get the word in time. Recently, several radical before-and-after famous faces have dominated the news, and not in a good way. Too many surgeries? Expectations too high? Perhaps, but the real problem lies in outdated, unnatural facelift techniques.

Global Facelift: Once and You’re Done
Before IV sedation (also called "awake anesthesia"), a full facelift from forehead to neck was not advisable in a single surgery. It was unsafe to have a patient under full general anesthesia, with a machine breathing for them, for many hours. The patient had to schedule individual procedures, which were often spread over time. This required multiple times under anesthesia as well as multiple recoveries, says Flaharty, and the results couldn’t be as natural as when everything is done together.

Also, there’s a nagging sense of incompletion.

Flaharty says, "When you do a little correction, the other areas stand out more. Imagine that you redecorate your living room but leave one old chair. That chair sticks out; looking worse than it did before. We don’t notice what’s gone; we notice what’s left.

"We now use IV sedation in combination with a local anesthesia containing low concentrations of epinephrine. The epinephrine restricts the blood vessels, substantially reducing the bleeding. Without bleeding, I see what I need to see and get done what I need to get done in a much shorter time. I’m able to do a global, or pan-facelift: brows, lids, face and neck—in a single three- to four-hour session. Because all elements are considered, and corrected, together, the effect is natural and harmonious. You have one or two weeks of downtime, and you’re done. With proper maintenance you’re good for the next 10 to 20 years."

The Endoscopic Vertical Facelift: Straight Up, Not to the Side
"As we lose elasticity in the skin, the face literally falls," says Prysi,
"creating jowls and gathers, and making creases at the corners of the mouth. We can fill in the creases, but we haven’t solved the problem because the skin is still hanging and the lower face still looks heavy. When a drapery begins to sag, you wouldn’t hem the bottom of the drapery, you’d lift the drapery back to where it was. The vertical facelift brings the jowl back up where it came from. Filling in lines doesn’t bring back the contours of youth or remove that tired, sad look. Fillers are best suited for fine lines, which I do post-op."

The Smile Test
"Watch your face as you smile hard into the mirror," Prysi suggests. "Your smile muscles lift your skin up from the cheekbone to the corners of the mouth. At 18, the skin remains in the same place whether smiling or relaxed; at 55, your smile brings cheeks and jowls temporarily back up, and you look more like your younger self.
"Because skin falls straight down, you can’t correct it naturally by pulling it to the side," he says. "Yet I would estimate that 95 to 99 percent of all facelifts are still done that way."

Fingernail-Size Incisions
"The old-style lateral lift also involves up to 14 inches of incisions and the removal of half an inch of skin at the sides of the face and the scalp. The downside of this is the ‘Hollywood sweep’ dramatically illustrated in some of the more famous overdone surgeries.
"With the endoscopic vertical lift, I make small incisions at the hairline and at the mouth, about the size of a fingernail," Prysi says. "Substantially less skin is removed. Because we retrace the steps of nature, there’s less possibility of an uneven result. The skin seals back to the bone in a week. In two weeks, most patients are going out to dinner, and after a month, even a doctor shouldn’t be able to know. An endoscopic vertical lift on a healthy 60-year-old patient should last 10 years."

SPF Factors Obsolete
There are plenty of ways to delay the facelift. Unfortunately, says Strohmeyer, preventing wrinkles with high SPF sunscreens isn’t one of them. Whether you’ve been spending $2 at the drug store or $80 at the cosmetic counter for the past 30 years or so, that SPF-45 rating did nothing more than block UVB rays to prevent sunburn. It wasn’t doing a thing to help prevent damage from the more dangerous UVA rays, which penetrate deeper and cause loss of collagen and elasticity, brown spots, wrinkles and skin cancer. In fact, she says, the sunburn is nature’s warning signal that we should get out of the sun. The false security of high SPF lotions actually make us more vulnerable. Strohmeyer says the FDA is currently working on a new grading system involving a star system for UVA, and misleading SPF labeling will be clarified.

Another word to the wise—four words, actually—from Strohmeyer: Titanium oxide and zinc oxide. They’re the essential ingredients to look for in your next sun protection product. Micro-size mineral particles added to the formulation make those evil UVA rays bounce off the skin instead of being absorbed into it, she says.

Another great UVA protectant, she adds, is Parsol 1789 (avobenzone). It absorbs the light, breaking it down to make it harmless.

Gulfshore Life found Strohmeyer-approved Neutrogena and Olay products over the counter for less than $15. At the Sanibel Harbour Resort and Spa, the luscious lavender and orange-infused 365 by Sonya Dakar is $38.50. Flaharty’s Azul Cosmetic Surgery and Medical Spa has its own line of potent anti-aging sun block priced at $25.44. Strohmeyer, a sports mom, personally loves Sport 45 by SkinCeuticals, $38.

Caviar, Darling?
In some cases, that $275-per-ounce jar of caviar goes around the eyes, not in the mouth. Naples skin care specialist Marie-Christine Elden, who has been counseling clients on anti-aging since opening La Femme Perfumery in 1984, says that the pure 24-karat gold micro-emulsions and micro-particles formulated with caviar and other marine products in the new line of anti-aging products by La Prairie "can bring back the skin’s youthful look and avoid surgery in the near future." Algae extract, for example, stimulates collagen synthesis and helps to inhibit the formation of new blood vessels, a primary factor in the formation of dark circles under the eyes. Other power ingredients address various issues: neuro-peptides help reduce the depth of wrinkles caused by the muscle contractions of facial expressions. Vitamin C, Daisy Flower Extract and Fruit Extracts help regulate pigmentation and brighten the skin. All that caviar and gold doesn’t come cheap; a single ounce of La Prairie’s best-selling skin caviar, Cellular Radiance Concentrate Pure Gold for the face, costs $525. Luckily, Elden says, a tiny bit goes a long way.