Quality of Life Innovations from the Columbia University Department of Surgery

Cosmetic Surgery

Staging of 'age maintenance' procedures through adulthood provides superior

Have you ever wondered why certain celebrities seem to age better than their
contemporaries? Why they look so good for so long? It may be because they
understand the importance of 'age maintenance,' and have taken continuous small
steps to care for their appearance.

When people wait until later in life to care for their appearance, they may end up
playing catch-up with cosmetic surgical procedures, requiring such extensive
changes that they look unnatural or "overdone," according to Robert T. Grant, MD,
Chief of the
Division of Plastic & Reconstructive Surgery at Columbia University
Medical Center. Dr. Grant recommends a more incremental approach, and specializes
in helping patients maintain or enhance their natural appearance over the course of
their adult lives.
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In the case of women, hormone changes associated with menopause significantly affect
the skin, says Dr. Grant. "It is far better to begin age maintenance treatments before
menopause occurs than after." Because menopause significantly reduces the elasticity
of a woman's skin, cosmetic procedures may not last as long as if they had
been performed prior to menopause. More 'nipping and tucking' might be required than would be the case in the same procedure performed on a younger woman.
In addition, fullness of the tissues under the skin of the face declines as a woman's hormone levels decrease in perimenopause, and a cosmetic
procedure's tightening of the skin across a face with less youthful plumpness underneath the surface can sometimes lead to a look that is unnatural or extreme.
Dr. Grant consults with patients through all stages of adulthood to help them understand what will work best when, and help them choose the least invasive,
most effective options. "Embarking on a lifelong plan for addressing one's skin health and appearance is like an investment in one's future," he says. "By taking
less invasive steps at an earlier stage, women can avoid the need for more dramatic, aggressive procedures in the future, maintain a more effective,
rejuvenated look longer, and save both money and recovery time in the long term."

Patients may want to consider the following steps to maintain a youthful appearance:

In their 20's:

  • Medical approaches including sun block, acne control, and topical creams and ointments that incorporate retinols and vitamin C;
  • Minimally invasive skin procedures such as dermabrasion;
  • Laser hair reduction;
  • Reduction of spider veins;
  • Commitment to personal fitness and weight control.

In their 30's:

  • Minimally invasive and non-surgical procedures including fillers and Botox in the face;
  • Surgical correction of abdomen, breast, or other tissues after pregnancy;
  • Discreet surgical procedures for the eyes, face, and neck, which can prolong the period of time that a woman looks her best as menopause approaches;
  • Light-based facial treatments including laser resurfacing, intense pulsed light or plasma.

In their 40's, 50's and beyond:

Chronological age becomes less important than a woman's physiologic age, says Dr. Grant: "Some skin is old at 40, and other skin not until later." As patients
age, procedures such as face lifts or neck lifts may be recommended according to their corrective benefits, rather than for prevention. Daily maintenance,
lifestyle, rest, and stress management are essential to looking one's best. In addition, patients may consider medical skin care, fillers, and "judicious use" of
Botox to reduce wrinkles.

"Plastic surgery is about quality of life, and about a woman's overall health and well-being," says Dr. Grant. "I partner with each of my patients to identify and
reach that balance of inner and outer beauty that is uniquely theirs, and to maintain that balance through every life stage."