The Surgeon Minute

An Expert Guide to Facial Rejuvenation for the 20’s, 30’s and 40’s

An Expert Guide to Facial Rejuvenation for the 20’s, 30’s and 40’s

Aging is a decades long process. It happens slowly, day by day and year by year. The best approach to facial rejuvenation is to counter the effects of aging in a likewise manner, bit by bit, not all at once.

Boston-based board certified plastic surgeon Dr. Christine Hamori encourages her patients to view facial rejuvenation as a lifelong process. For Hamori, the key to successful rejuvenation treatments at any age is maintaining a natural appearance. She takes a less-is-more approach, often encouraging patients to “hold off” on additional treatments or injections until the appropriate time. Here she outlines the potential options for patients in their 20’s through 40’s, the decades before surgical intervention is necessary.

The Early 20’s – Lip Augmentation

“In their early 20’s, it’s all about the lips,” emphasizes Dr. Hamori. “They see Kim Kardashian, they see these women with beautiful lips, and they want to have a little bit of enhancement.” Over-injected lips have earned lip fillers a bit of a bad reputation. When done conservatively, however, they can improve both the shape and fullness of the lips without looking artificial. The amount of filler used and the type of filler injected play important roles in achieving natural-looking results.

“My go-to product in a younger patient is Volbella, which is a specially formulated hyaluronic acid in the Allergan Juvederm family,” shares Hamori. “It really gives a nice hydration to the lip and gives a very natural result that lasts nine months to a year.”

The Late 20’s and Early 30’s – Fine Lines and Wrinkles

In the late 20’s and early 30’s, women begin to notice the first signs of wrinkles around the eyes. Squinting causes crow’s feet to appear at the outer edges. Furrowing the brow creates vertical lines commonly referred to as the “Elevens” between the eyes. Any animation of the face – laughing, crying, smiling, wincing – causes creases, which overtime become permanent in the form of wrinkles and fine lines.

At this early point in the aging process, lines and wrinkles have not yet become deeply etched in the face. Repeated use of the muscles in the forehead and around the eyes – from things like laughing, crying, smiling,  and wincing – will cause the lines to become more noticeable and permanent over time. “Whether they are in the late 20’s or early 30’s, I usually start neuromodulators, Botox or Dysport, to try to relax those muscles,” explains Hamori. “It really helps to prevent those deep creases, those ‘Elevens’ or the transverse forehead lines.”

Hamori’s less-is-more approach also applies to neuromodulators like Botox.  Her goal is to prevent wrinkles and achieve a relaxed expression while still allowing motion and movement in the face that looks natural.  

Botox and Dysport are useful for more than just wrinkle prevention: they have the ability to help shape the eyebrow in younger patients. By weakening the strong facial muscles that pull the outer eyelid down, Dr. Hamori is able to provide her patients with a lift of the eyelid and brow without surgery. “You really can give a more youthful appearance, open the eyes up, and change a lot of the dynamics around the eye and expression, by using these neuromodulators,” she explains.

The Late 30’s and Early 40’s – Volume Loss

As women enter their late 30’s and early 40’s, they begin to “look old.” The cause of this is a dramatic loss in facial volume. What makes babies and children look so young? A fat, full face! As time goes on, this volume is lost, leaving sharp features and sometimes a border-line gaunt look. To offset deflation, Dr. Hamori uses injectable fillers to restore lost volume.  

One popular category of facial fillers are composed of hyaluronic acid. Hyaluronic acid is a substance that is naturally found in the human body, but it diminishes with age. Two popular brands of hyaluronic acid-based fillers are Juvederm and Restylane. Each brand has several versions of filler specifically formulated to address volume loss in different areas of the face, such as the lips, nasolabial folds or cheeks.

“There’s also Sculptra or poly-L-lactic Acid, which is a favorite of mine,” adds Hamori. “You inject it, you massage, and it volumizes your skin naturally.” Unlike other injectable fillers, Sculptra can help restore lost collagen, improving skin quality as well as provide long-lasting volume restoration.

The 40’s – Non-Surgical Skin Tightening

During the 40’s, the signs of aging worsen as the skin of the face becomes lax. As a result, the jawline sags and the eyelids begin to droop.  

There are several treatment options Dr. Hamori suggests to tighten skin and stimulate new collagen growth. “First, you want to make sure you’re using the right skincare,” says Hamori, “Then you could try some non-invasive modalities, such as Ultherapy, which is micro-focused ultrasound. You also could use radiofrequency, whether it’s Thermage or Pelleve.”

Both ultrasound and radiofrequency treatments deliver a controlled heat to the inner layers of the skin, stimulating new collagen growth, resulting in a tightening effect of the skin. These treatments, being non-surgical, only affect minimal rejuvenation, which is perfect for patients who are beginning to have loose skin but are far from needing surgical help.

Non-surgical skin tightening options:

  • Ultherapy
  • Thermage
  • Pelleve

Another common sign of aging that may become noticeable in the late 40’s is the appearance of thick bands, known as platysmal bands, in the neck. Dr. Hamori successfully uses neuromodulators, such as Botox or Dysport, to improve the appearance of platysmal bands.

Beyond the 40’s – Surgery

In bygone days, patients looking to rejuvenate their face waited until the last possible moment to consider a trip to a plastic surgeon’s office. At this point, surgical intervention is required to remove excess skin in the neck, face, and eyelids. The goal of modern plastic surgery is to ease patients into this scenario by utilizing the therapies and treatments noted above. If a women were to utilize fillers, Botox, and non-surgical tightening procedures, they may be pushing surgical options much farther down the line. Whether or not this is the case, they will age “slower” and feel better, all without requiring surgery that comes with downtime. Embracing and utilizing the growing toolbox of non-surgical options has allowed for graceful aging.

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