Flattening the Aging Curve at Reddy Aesthetics
In recent months there has been much discussion regarding the flattening of curves. The most obvious curve that has been the subject of efforts of flattening is very appropriately the COVID19 infection curve. Yet another curve that has perhaps received less discussion is the flattening of the economic curve due to the implementation of various economic stimulus packages during the pandemic. The injection of government capital into the business environment has reduced the numbers of businesses likely to fail due to the pandemic and thus slowed, or flattened, the rates of business failures.
As a Plastic Surgeon, one curve that our field of study has always thought about is the Aging Curve. The Aging Curve simply refers to the rate at which an individual experiences physical changes over time. For example, the first two decades of life witness dramatic changes as a result of normal growth and development and in this period the Aging Curve is at its steepest. The period between the third and fourth decades (20s-30s) of life are marked by relative stability in the rate of physical changes and one can think of the Aging Curve as having been flattened during this period.
From the fifth decade onwards, the Aging Curve begins to steepen again and individuals begin to experience an increase in changes as a result of normal senescence. The Aging Curve then flattens around the 7th decade of life and maintains a relatively shallow ascent from this point onwards.
As a Plastic Surgeon, it is my goal to “flatten” the aging curve and our efforts tend to focus on the period from the late 40s onwards. Younger clients are seeking correction or enhancement of specific features such as rhinoplasty, breast augmentations, liposculpting or simply a healthy maintenance regimen.
The simplest way to flatten the aging curve is embracing a healthy lifestyle which includes measures such as good skin care regimens and avoidance of UV light exposure. Obviously genetics plays an important role in how we age and simply observing how our parents age is a good indicator as to the changes we can expect to see in ourselves with the march of time. As we continue to age, physical changes such as shrinking facial fat compartments and loss of collagen and soft tissues, and even bone resorption become manifest as sagging facial tissues and wrinkles. Fortunately, many of these changes may be easily addressed with injectables such as Dysport and HA (hyaluronic acid) fillers. When the aging curve is flat, or less steep, a single syringe of filler is sufficient to produce improvement. The steeper segments of the Aging Curve demand more volume and greater variety in the application of fillers as well as a skilled injector. In other words — as one ages, more filler volume is required to produce the desired results. For a client in their 50s, a reasonable rejuvenation is achieved with the application of 2-3 syringes of an assortment of fillers combined with Dysport. For example, aging of the mid and upper face may be corrected with Restylane LYFT whereas the lower face jaw line refinement may require Radiesse. Tear troughs, nasolabial folds, marionette lines and lips are best treated with “softer” fillers such as Prollenium Versa or Restylane Silk. The artful application of proper fillers and neuromodulators is often sufficient to correct aging within a certain range of the aging curve.
Beyond a certain age, the effectiveness and cost efficiency of in-office injectables tends to diminish and it is at this point that one must consider surgical interventions in order to restore and rejuvenate. For facial rejuvenation, this includes treatments such as facial fat grafting, lid lifting and face lifting. For the body, one might consider body sculpting, breast lifting and even vaginal rejuvenation.
In order to illustrate how one might think about and formulate treatments to flatten the aging curve, I have used Prince Charles as an example. The following photographs show HRH at different ages and my recommended treatments.
The above series of photographs shows Prince Charles as an infant through his early 20’s. This is the steepest segment of the Aging Curve and is the result of normal development and maturation. The facial skeleton achieves full maturity by the late teens, although it may continue into the early 20s in some cases. Facial fat pads are at their fullest during this portion of the Aging Curve. It is interesting to note that the ear is 80% of it’s full size by 6-years of age and this is illustrated by comparing the second photograph from the left to last picture in the row.
The above two pictures show Prince Charles in his late 30s to the early 50s. He demonstrates rapid changes in a relatively short period and is clearly on the steep portion of the aging curve. At this stage, I often recommend a combination of at least 2-3 syringes of filler combined with Dysport as a maintenance regimen in order to slow the progression of age. I will note that the subject appears to have experienced weight gain in the photograph on the right which has helped rejuvenate his facial features. Nonetheless, one can see the shape of the face gradually transforming from an oval to a more square shape.
Prince Charles is pictured in 2010 at age 61 on the left and in 2020 at age 71 on the right. This is the age range where fillers and Dysport are not as effective and it is time to start considering more invasive interventions such as facial fat grafting, face lifting, or eyelid surgery. The Aging Curve is not as steep as from the 40s to 60s. Deep peels or LASER resurfacing still deliver value. Interestingly, Prince Charles appears more rejuvenated and rested in his 2020 photograph. Incidentally, he does appear to have a touch of rosacea which would benefit from IPL.
P. Pravin Reddy, MD is a Board Certified Plastic & Reconstructive Surgeon and a member of the American Society of Plastic Surgeons.