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Turning Back Time

New Face, New Outlook

Reviewed by Craig H. Kliger, MD

WebMD Feature

Dec. 18, 2000 -- When Joan Kron set out to write a first-person account of shopping for a facelift, the New York City journalist interviewed four plastic surgeons but had no intention of ever having the surgery.

But as each physician described how he could refresh her appearance, she became more open-minded about looking as young as she felt. By the last office visit, she says, "I had crossed the line from stealth journalist to consumer."

So in 1992, at age 64, Kron underwent a facelift. "It was a wonderful experience," says Kron, author of Lift: Wanting, Fearing, and Having a Face-lift.

Cosmetic surgery has surged in popularity, and Hollywood stars aren't the only ones turning back the hands of time. People like Kron are among the biggest new fans of cosmetic surgery, according to the American Society of Plastic Surgeons in Arlington Heights, Ill. Patients aged 50 and older accounted for one third of all cosmetic surgery procedures in 1998, the latest year for which age-related information is available from the society -- and those 65 and over are the fastest growing of this segment. In 1998 alone, patients 65-plus had 90,911 procedures, up a whopping 272% from 1992.

What's happening here? Several factors seem to be behind the boom. Health-conscious 65-year-olds "realize that they have another 20 to 30 years to socialize," says Brian Kinney, MD, an assistant clinical professor of plastic surgery at the University of Southern California School of Medicine in Los Angeles. And common illnesses, such as arthritis, diabetes, and heart disease, do not exclude patients from having cosmetic surgery, as long as their physician clears them. Plus, in a booming economy, more people can afford such elective surgery.

A Smorgasbord of Options

Seniors are not lining up solely for facelifts. New methods make it easier for plastic surgeons to correct specific problems and spare or postpone facelifts for later years. "With facelifts, you pull. If you droop 109 years later, you pull again," says Kinney. "But a pulled face looks tight and unnatural."

After Kron had her facelift in 1992, she couldn't drive for a month because tightness in her jaw made it impossible to turn her head to safely back out of her driveway. These days, new and subtler procedures make patients look more natural and help avoid such side effects.

Besides facelifts, there are other possibilities. Laser resurfacing, for instance, vaporizes the superficial layers of damaged skin and helps firm the deeper layers with high-energy light, allowing new, smoother skin to emerge. In the last five years, lasers have largely replaced deep chemical peels that use harsh chemicals to rejuvenate facial skin. Wrinkles around the eyes and mouth and on the cheeks respond well to laser resurfacing.

Laser resurfacing does not work well, however, on much deeper frown lines, forehead creases, and crow's feet. But these wrinkles do tend to fade after injections of Botox (a brand name for botulinum toxin, the substance that causes a deadly form of food poisoning). When injected in tiny amounts, this substance "cuts down the nerve activity that causes these wrinkles," says plastic surgeon Fritz Barton, MD, a clinical professor at the University of Texas Southwestern Medical School in Dallas.

The tiny amount of Botox injected shouldn't harm the rest of the body but banishes wrinkles for three to six months. "People get Botox twice a year for one, two, or three years until they're ready for a facelift," says Barton.

Eyelifts, or blepharoplasties, involve removal of fatty bags and droopy skin on the eyelids and can cut years off a person's appearance. Of all blepharoplasties performed in 1999, 63% were in people older than 51, according to the American Society of Plastic Surgeons.

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