The vast majority of patients see bothersome aging changes in their 40’s (Darker skin types usually see these changes in their mid 40’s). This is when most patients begin to think about preventative procedures and present to their plastic surgeon. Because everyone ages differently, the preventative procedures depend on the type of aging present.
- Every 40 year old patient, male or female, should be on a daily skin care regimen. The premise is to maximize collagen preservation and production during this decade. Every year after the age of 30, we lose a percentage of collagen and elastic tissue. We cannot stop the aging process but a daily skin care regimen can improve collagen production, minimize collagen and elastin breakdown, slow the thinning of skin, minimize brown spots, texture changes, pore size, and the depth of wrinkles and lines.
- Boosting the skin care regimen with monthly medical grade facial treatments (Hydrafacial MD) which can exfoliate, extract, infuse, and hydrate is highly recommended.
- Skin care should consist of a cleanser (Gentle or Brightening Cleanser), antioxidant (CE Brightening Serum), retin-A (Exfolibright C), and a medical sunblock (Visage SunGuard) at a minimum. During this decade, most people also add an active neck cream (Neck Enhance Complex) and active eye cream (Eye Enhance Complex) to start treating these areas. Of course, oily skin and dry skin require different concentrations of the above regimen which we customize and compound in our office.
- Individuals who are starting to see brown spots can use IPL or topical lightening agents to begin treating the spots and prevent them from getting worse. Women with melasma or hormonal pigmentation do very well with our pigment peels (Visage MD Brightening peel).
Lines, Wrinkles, Folds, and Volume
- The vast majority of 40 year olds should be using Botox or Dysport to prevent and control dynamic lines (lines that occur as a result of movement). These lines include forehead lines, lines between the brows, lines around the eyes, vertical lines around the lips, neck bands, and even pout lines and chin dimples. Over time, these lines get deeper and much harder to eliminate or even improve.
- Botox or Dysport also prevent brow drooping, corner of mouth drooping, and neck bands in addition to lines.
- Most 40 year olds also start to see folds between the nose and corner of the mouth (nasolabial folds) or even drooping at the corners of the mouth or hollowing under the eyes. Some start to see loss of jawline or neckline definition.
- Nonsurgical lifting is important to use at this point to prevent further downward descent of tissues, blunting of a sharp jawline or chin, and eventual stretching of the skin which would require surgery in the future.
- Our trademarked nonsurgical face, eye, and neck lifts (the MM Lift™) uses a customized approach to lift and support tissues in addition to fill lines and folds. The MM Lift uses a combination of volumizing facial fillers throughout the face (not just the cheeks) to create a natural result. Fat transfer and implants are also options for volume. Going to a plastic surgeon who specializes in nonsurgical modalities and who trains other physicians can help you determine the best filler based on the characteristics needed for your face.
- Chin fat can increase during this decade. Consider Coolsculpting, Kybella, or neck liposuction to maintain neckline. In late 40’s, Ultherapy may be needed to tighten loose neck skin in combination with chin fat treatment.
- Lip volume begins to decrease during this decade and vertical lines around the lip border begin to appear. Using filler or implants to provide your lips with an age appropriate appearance also helps with supporting the corners of the mouth, lip border definition, improvement in lipstick lines, and marionette lines going forward.
- Ultherapy is a great preventative treatment for the 40 year old to maintain or improve current brow position, jawline, or neckline and is highly recommended at this stage (or earlier). Ultherapy is also great for individuals who want to lift loose skin that they are just beginning to see. Many individuals have both loss of volume and skin laxity so it’s important to determine if volume is needed in addition to Ultherapy to avoid an underwhelming Ultherapy result.
- During the late 40’s, in some cases, there isn’t enough skin elasticity to recommend ultherapy, and the best way to proceed is to tighten the skin by first performing a browlift>, eyelid surgery, necklift, or facelift and then using ultherapy as a maintenance therapy. Our Signature Natural surgical procedures provide a refreshed and natural finish. The idea is for someone to be able to sit right next to you and not know you had anything done.
- Radiofrequency Microneedling (Infini Genius) is a proven way to increase collagen in the top layers of the skin, smooth irregularities, improve acne scars, but most importantly, tighten skin. This is great for thin crepey skin in the neck and around the eyes. This is commonly used after a facelift to make the result last as long as possible and is, similarly, used to keep younger skin from becoming lax.
- Fractionated CO2 laser is also a great way of tightening the top layers of the skin, much like radiofrequency microneedling, but it also improves brown spots and evens skin color. Fractionated CO2 cannot be used in darker skin types so microneedling is used instead. Radiofrequency microneedling (Infini Genius) has no downtime and no sun restrictions but has to be repeated at least 2-3 times to equal one laser treatment. CO2 laser has downtime of about one week and sun avoidance for one month.
- Fractionated CO2 laser and radiofrequency microneedling both smooth and tighten the superficial layers of the skin and create collagen in the top layers. Ultherapy tightens deeper tissues for lifting purposes.
- Frequently untreated, a thinning hairline, eyebrows or eyelashes can change the framing of the face making the face look older. Platelet Rich Plasma (PRP) injections for thinning of the anterior hairline are very popular to thicken the density of hair long the hairline and to make the hair darker and longer. PRP can also be used for eyebrow hair thinning as well.
- A large forehead can often be reduced at the time of a browlift or mini facelift to advance the hairline anteriorly and to reduce the appearance of a recessed hairline or prominent forehead. PRP injections are generally used afterwards to maintain the appearance of the anterior hairline.
- Latisse is commonly recommended during this decade to help the eyelashes become longer, thicker, and darker. Eyelashes improve the framing of the eye and enhance the appearance of eye procedures performed in this area. It also distracts from a low brow or a heavy upper lid.
Unsure where to start? Call us for a complimentary cosmetic consultation and we can create a customized prevention plan just for you!