Why Nobody Deserves To Sag: You Wouldn’t Buy A Rolls Royce Without Getting It Serviced, Right?

Every day I’m bombarded with dozens, if not hundreds of these outcries: “My face is falling. I have developed these jowls I never had before! I don’t mind aging, and I don’t want surgery, but can I do anything to help without looking overdone?”

First off, let’s agree that aging should be exclusively reserved for a fine bottle of wine. It’s probably the only circumstance in which it has a positive connotation. Let’s keep it that way. On a human level, I would rather refer to the whole thing as a “maturing” process—a process through which one becomes wiser. It’s the 2.0 version of reality, and I’m sticking to it.

On Loving You—And Aiming For The Well-Tailored Suit Version Of You

With my newfound wisdom (and reality), I have become more confident and secure throughout the years. Decades ago, despite having plastic-wrap-tight skin, a pimple on my nose would have kept me home. But today, I’m a free bird, one who embraces her occasional blemish. I try to instill this perspective in my patients, in hopes that they’ll love themselves inside and out, despite the occasional setback—occasional being the key word.

Yes, yes yes, you should love yourself above all, no matter what. However, the “you” in a well-tailored suit versus the “you” in an ill-fitting blazer and slouchy pants are two very different versions of you. Therefore, I urge you to ask yourself, in which version do you feel better about yourself?

In the exact same manner, our skin is our natural draping, through which we present ourselves to the world. Like a brand new ironed shirt, we become wrinkled, then blotchy over time. Eventually we even start to sag in certain areas… and this is where I draw the line: no one deserves to sag. Sagging is a horrible word and an even more horrible concept.  

Preventing The Sag: Maintenance

It is a misconception that some people believe this stage must be reached before they can do anything to help themselves. Au contraire mes amies, this is where maintenance comes into play! No one buys a Rolls Royce without getting it serviced, and you, my friend, should consider yourself a Rolls.

So what exactly is maintenance, and when do I start?

You start young, and a proactive skin care routine is a must. If you’re lucky, you’ve been marinating your skin with daily sunscreen (minimum SPF 30) for as long as you can remember. We’ll dive into the details of a thorough skin care routine next time. But, for the purposes of avoiding the sag, an active at-home regimen should include nightly vitamin A cream (retinol or retinoic acid), which helps the skin renew itself faster and appear firmer.

Noninvasive Maintenance, Including Heat + Radiofrequency

Once you’re ready to venture out of the confines of your home and into an exam chair, noninvasive procedures can help delay the inevitable. Heat is a potent source of energy that allows fibrous bands to tighten while stimulating new collagen to develop. In recent years, cutting edge technologies have been developed to help deliver the heat to specific levels of the skin. Warming of the most superficial layers of skin can be achieved through electrical radiofrequency energy such as ThermiSmooth™. This results in smoothing out fine lines, and tightening thinner skin such as the upper eyelids (i.e. an eyelift without surgery). Ulthera® offers a deeper micro-focused delivery of heat beneath the skin’s surface via ultrasound energy. This noninvasive treatment leads to lifting in addition to the tightening. Such treatments can be performed once every couple of years—as maintenance.

Conquering Your Fear Of Injectables

To the uninitiated, injectables can sound positively frightening. Often times, patients initially object because of the surrounding stigma and fear of having a “muzzle” look. First off, I tell all of my patients that the word filler should be banned. As a physician, I have been trained to always look for the cause of a symptom. As such, a skilled injector knows never to use an injectable to fill a defect—we use it to treat the cause of the defect, resulting in a lifted and rejuvenated look. These treatments last six months up to a year, and can be repeated as needed (within reason). Again, you should see this as maintenance.

The toolkit of injectables range from non-permanent solutions such as hyaluronic acid (such as Restylane® and Juvederm Voluma®), to semi-permanent treatments like calcium hydroxylapatite (Radiesse®) and poly-L-lactic acid (Sculptra®). I personally do not recommend permanent injectables in the face due to the risk of irreversible damage if vascular occlusion occurs.

When performed synergistically, the combination of noninvasive procedures with injectables help us maintain our faces’ youthful contour, and over time delay (fingers crossed, forever!) the dreaded facelift.

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