September 17, 2024 • 14 mins
Reaching your 80’s is a special time in life. This decade is different for different folks: some are preoccupied with health issues and spend most of their time at home, while others are still very healthy, active, and social.
In this seventh and final episode of our mini series “Decades of Face,” Dr. Bass shares the top cosmetic procedures for people in their 80’s and how to find a new surgeon if yours has retired at this point.
This is the time to reinforce whatever work you've done previously with non-surgical treatments and occasionally a small surgery.
We’re usually not surgically lifting at this point. While some people are having a second or third facelift or neck lift, most people are more concerned about restoring volume and improving skin quality.
Learn which treatments Dr. Bass recommends during this decade to improve volume loss, skin quality, and deep wrinkles.
Learn more about facial fat grafting, skin quality treatments, and laser skin resurfacing
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to Park AvenuePlastic Surgery Class,
a podcast where we explore controversiesand breaking issues in plastic surgery.
I'm your co-host, Doreen Wu,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator, and technology innovator.
(00:21):
The title of today's episode isDecades of Face: The Eighties,
The Reinforcement Decade.
We're here at the final episodeof our Decades of Face series,
the end of the line, the eighties. Youalready know what I'm going to ask.
Tell me about the title, Dr. Bass.
Sure, Doreen.
The titles in all of theseepisodes try to frame the
(00:42):
perspective about how you shouldapproach care in this decade.
In this case, the messaging isreally about the eighties and beyond.
This is a time to reinforcewhatever work you've done previously
with treatments and occasionallywith a small surgery.
And what's going on in this decade?
(01:04):
It's very different for different folks.
Some people are very healthy and active,
some are preoccupied with health issues.
Some people are really not beingvery social or not very much at this
point, and others are stillvery active in social.
So what does this mean treatment wise?
(01:25):
It means you pick the amount and typeof treatments based on how much you
want and need.
And is that all?
No, actually selection is alsobased on the foundation of
renovation that you'vebuilt previously in earlier
decades that will speak to whichfeatures are in good shape and which
(01:47):
ones need some work.
What does this entail? How can I figureout an appropriate treatment plan?
This, as we've said multipletimes on the podcast,
points out the importance of carefulplanning with a skillful and experienced
plastic surgeon.
If your plastic surgeon of pastdecades is still practicing,
(02:09):
they know where you've beenand can see where you're going.
If that surgeon has retired,
find an experienced surgeon who'slooking at details and planning
with you to fulfill yourindividual goals and needs.
Someone who will rightsize a planthat will help you look your best,
(02:31):
but be something medically safe andcomfortable to do at this point in your
life.
Okay. I'm starting toget it. At this stage,
a lot of aging has taken place andthere is some variation to be expected
based on genetics, lifestyle, overallhealth, and previous plastic surgery.
Still, I feel like I need some ideaof what kind of things to look for.
(02:54):
What are typical options at this stage?
That's a great way to look at it.
It think about the typicaland easy to do options,
consider somewhat more involvedoptions if a feature is really
pronounced,
and we're going back to ourbig categories of treatment.
So Botox and other neuromodulatorsare still helpful at this stage.
(03:18):
They don't tend to correctquite as completely due to a
greater degree of fixed wrinkling,
but dynamic wrinkles stillrespond and at this stage,
they may actually take a little longerto wake up and regenerate the muscular
activity
than they did when youwere somewhat younger.
(03:41):
So it's one of the few things thatactually gets a little bit better as we
age.
The next big category would be fillers,
and these are our mainstay ofwhat we do at this point in
time. You need to usemore than previously,
but volume loss is a prominentfeature of aging at this stage,
(04:03):
so doubling down onthis approach of volume
restoration pays bigdividends for large volumes
or more complete corrections.Some people choose fat grafting.
Now this is a procedure,
but it's a minor one with minimalrecovery and minimal surgical
(04:24):
stress.
Energy treatments are alsoa major player at this
stage. Skin,
which is our surface protection againstthe elements is definitely not its best
at this stage and pretty universally shows
significant signs of aging.
(04:46):
So anything that globally improvesskin quality will make us look
markedly younger.
And this is a very broad range oftreatments from very light treatments to
somewhat heavy treatments.
It could be a small series ofno recovery treatments like
intense pulsed light up to majorrelease or peels with a week
(05:10):
of recovery, but stillno surgery or incisions.
Because of this whole rangeof options and even within
an option,
the ability to vary theintensity up and down the scale,
we can kind dial in what you need based on
(05:31):
what you've done previously andhow prominent the feature is.
So as an example, brown spots,
which were also calledage spots or sun spots,
would slant treatments one way.
If we're chasingpredominantly rough texture,
that will respond to awhole range of treatments,
(05:54):
and if we're chasing deep wrinkles,
we're either going to need anumber of light treatments or
one heavier recovery based treatment,
but still no surgery.
I noticed you haven't said a lot aboutskin laxity treatments. Why is that?
That's very observant.You're exactly right.
(06:16):
This is not the main timepoint when we're chasing skin
laxity as a feature.
It's still worth talking about thoughthere are people who are having a second
or third facelift at this time,
or more typically a neck lift becausethat's really the area that gives out.
(06:36):
The face typically only needsvolume and has reaccumulated only a
little bit of laxity,
but the neck usually shows somehanging skin and some muscle banding,
and it typically is relapsed to the pointwhere there's some more obvious need
for correction. For those whopreviously had a facelift,
(06:56):
a neck lift, the small amountof laxity may be a minor issue.
It's not what's really showing whatdecade we're in at this stage of the
game. It's relatively minor,
so some people choose to focus onvolume and skin surface at this
point, as I've already mentioned,
(07:20):
because those are the areas where moresevere findings are typically present
and the treatments are lessinvasive and have a minimum of risk.
But for people who have putoff having a surgical lift,
they will on occasion choose toproceed at this point in their early
to mid eighties. But for many folks,
(07:42):
this is really more than what they'relooking for at this stage of life.
I think it makes a lot of sense to not be
surgically lifting at thispoint, although again,
there are certainly individual exceptionsfor people who are very healthy and
active,
and I've seen some excellent resultsin folks at this stage if they're
(08:05):
properly selected andthey're good candidates.
I also noticed that you still haven'tsaid anything about non-surgical laxity
treatments. If I'mtrying to avoid surgery,
isn't this a good option for gettingsome degree of laxity improvement?
Actually, Doreen, the answer is no.
Let's look at the biology ofhow these devices work. I mean,
(08:27):
when a plastic surgeondoes a surgical facelift,
excess skin is mobilized andredrapes smoothly and the
excess is trimmed away. Somepeople respond more completely,
some less,
but it's a major change in everyonebecause we're just mechanically
removing that excess skin.
(08:48):
Non-surgical laxity treatmentssimply don't work in this
fashion. Whether the treatmentis laser, ultrasound,
radiofrequency, or someother form of energy,
the mechanism of action iscreating a controlled thermal
effect in or below theskin or at both depths.
(09:11):
And the body's response tothis biological stimulus
creates new collagenand collagen remodeling.
So collagen removal andcollagen replacement,
the response to these treatments iswholly dependent on how effectively your
body mounts a response to thestimulus of the treatment.
(09:34):
Unfortunately, as we age,this response diminishes,
which is partly why we showlaxity in the first place,
and at this point in your eighties,
it can pretty reliably becounted on to belittle to none.
So those who need laxity changethe most are least able to benefit
(09:56):
from energy treatments forlaxity. In simple terms,
you can push your skin,
but your skin has retired 10 or 20 yearsearlier and it isn't going to make a
meaningful response.
Your skin can heal and do some thingsthat we want with various aesthetic
treatments,
but laxity changes are modestwith energy treatments,
(10:19):
even when people are in theirforties or fifties at that stage,
a modest response for the modestlaxity that's likely to be
present, that's a pretty good fit,
but at the point whereyou're in your eighties,
it's just not a useful approach anymore.
Energy treatments for wrinklestypically don't show quite as good a
(10:41):
response either as when they'redone in an earlier decade,
but the response is still robustenough that these treatments are quite
useful. But laxity treatments not so much.
What about biologicaltreatments like PRP or stem cell
responses to the stem cellscontained in fat grafting?
(11:04):
That's a great question because you'dthink that if you are actually giving some
of the biological mediatorsback into the skin,
that that would make up forsome of the aging change.
But this is a very complexprocess how all of these
signaling agents,
growth factors and otherthings talk to each other,
(11:28):
and recent studies haveshown that there's a
decline in people in theirsixties and beyond in the
ability to make use ofthis kind of signaling
and create a visibleimpact on skin appearance.
So it doesn't mean thatit's useless at this stage,
(11:50):
but the response is blunted compared todoing kind of treatment in your forties
or fifties.
Okay. Dr. Bass,
can you give our listeners some partingtakeaways from this final decades of
face episode?
Absolutely. So at this stage,
some people have given upon chasing their appearance,
(12:10):
but other people are still very active.
So very variable what you'regoing to choose to do,
but in general,
we're trying to avoid surgery justbecause we want to keep it simple,
not take any unnecessary risks,
but there are individual exceptionswhere a small surgery or even a
fair size surgery can be veryuseful. But overall, again,
(12:35):
we're trying to support everything likethe little boy with his finger in the
dyke.
We're just trying to hold things togetherwith the simplest things we can get
away with. So we want to keepthe best appearance we can,
but keep it simple. However,
that doesn't always meantiny amounts. So for example,
with filler, it'snon-surgical, it's no recovery,
(12:59):
but you're not going to get away with asyringe of filler globally on the face,
you're going to be doing bigger volumes.
Surgery's only going to be for people whoare totally healthy and the procedures
should be limited, not extensive.
Remember the sensiblepriorities always safety
(13:22):
first, then looking totally natural,
then the youngest look we can produce
still, a lot of things can be done atthis stage that are very meaningful,
and a lot of the non-surgicaltreatments like fillers and basic
skin laser treatments like IPLcan make a drastic difference
(13:45):
in how old you look.
Thank you, Dr. Bass for sharingyour insight and expertise with us.
And thank you to our listeners for joiningus today to finish out our Decades of
Face series. Stay tuned,
another series Central to theCutting Edge Plastic Surgery.
We'll be starting very soon.
Thank you for listening to the ParkAvenue Plastic Surgery Class podcast.
(14:05):
Follow us on ApplePodcasts, write a review,
and share the show with your friends.
Be sure to join us next time to avoidmissing all the great content that's
coming your way. If you want tocontact us with comments or questions,
we'd love to hear from you.
Send us an email at podcast@drbass.netor DM us on Instagram
@drbassnyc.
Welcome to Park AvenuePlastic Surgery Class,
a podcast where we explore controversiesand breaking issues in plastic surgery.
I'm your co-host, Doreen Wu,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator, and technology innovator.
(00:21):
The title of today's episode isDecades of Face: The Eighties,
The Reinforcement Decade.
We're here at the final episodeof our Decades of Face series,
the end of the line, the eighties. Youalready know what I'm going to ask.
Tell me about the title, Dr. Bass.
Sure, Doreen.
The titles in all of theseepisodes try to frame the
(00:42):
perspective about how you shouldapproach care in this decade.
In this case, the messaging isreally about the eighties and beyond.
This is a time to reinforcewhatever work you've done previously
with treatments and occasionallywith a small surgery.
And what's going on in this decade?
(01:04):
It's very different for different folks.
Some people are very healthy and active,
some are preoccupied with health issues.
Some people are really not beingvery social or not very much at this
point, and others are stillvery active in social.
So what does this mean treatment wise?
(01:25):
It means you pick the amount and typeof treatments based on how much you
want and need.
And is that all?
No, actually selection is alsobased on the foundation of
renovation that you'vebuilt previously in earlier
decades that will speak to whichfeatures are in good shape and which
(01:47):
ones need some work.
What does this entail? How can I figureout an appropriate treatment plan?
This, as we've said multipletimes on the podcast,
points out the importance of carefulplanning with a skillful and experienced
plastic surgeon.
If your plastic surgeon of pastdecades is still practicing,
(02:09):
they know where you've beenand can see where you're going.
If that surgeon has retired,
find an experienced surgeon who'slooking at details and planning
with you to fulfill yourindividual goals and needs.
Someone who will rightsize a planthat will help you look your best,
(02:31):
but be something medically safe andcomfortable to do at this point in your
life.
Okay. I'm starting toget it. At this stage,
a lot of aging has taken place andthere is some variation to be expected
based on genetics, lifestyle, overallhealth, and previous plastic surgery.
Still, I feel like I need some ideaof what kind of things to look for.
(02:54):
What are typical options at this stage?
That's a great way to look at it.
It think about the typicaland easy to do options,
consider somewhat more involvedoptions if a feature is really
pronounced,
and we're going back to ourbig categories of treatment.
So Botox and other neuromodulatorsare still helpful at this stage.
(03:18):
They don't tend to correctquite as completely due to a
greater degree of fixed wrinkling,
but dynamic wrinkles stillrespond and at this stage,
they may actually take a little longerto wake up and regenerate the muscular
activity
than they did when youwere somewhat younger.
(03:41):
So it's one of the few things thatactually gets a little bit better as we
age.
The next big category would be fillers,
and these are our mainstay ofwhat we do at this point in
time. You need to usemore than previously,
but volume loss is a prominentfeature of aging at this stage,
(04:03):
so doubling down onthis approach of volume
restoration pays bigdividends for large volumes
or more complete corrections.Some people choose fat grafting.
Now this is a procedure,
but it's a minor one with minimalrecovery and minimal surgical
(04:24):
stress.
Energy treatments are alsoa major player at this
stage. Skin,
which is our surface protection againstthe elements is definitely not its best
at this stage and pretty universally shows
significant signs of aging.
(04:46):
So anything that globally improvesskin quality will make us look
markedly younger.
And this is a very broad range oftreatments from very light treatments to
somewhat heavy treatments.
It could be a small series ofno recovery treatments like
intense pulsed light up to majorrelease or peels with a week
(05:10):
of recovery, but stillno surgery or incisions.
Because of this whole rangeof options and even within
an option,
the ability to vary theintensity up and down the scale,
we can kind dial in what you need based on
(05:31):
what you've done previously andhow prominent the feature is.
So as an example, brown spots,
which were also calledage spots or sun spots,
would slant treatments one way.
If we're chasingpredominantly rough texture,
that will respond to awhole range of treatments,
(05:54):
and if we're chasing deep wrinkles,
we're either going to need anumber of light treatments or
one heavier recovery based treatment,
but still no surgery.
I noticed you haven't said a lot aboutskin laxity treatments. Why is that?
That's very observant.You're exactly right.
(06:16):
This is not the main timepoint when we're chasing skin
laxity as a feature.
It's still worth talking about thoughthere are people who are having a second
or third facelift at this time,
or more typically a neck lift becausethat's really the area that gives out.
(06:36):
The face typically only needsvolume and has reaccumulated only a
little bit of laxity,
but the neck usually shows somehanging skin and some muscle banding,
and it typically is relapsed to the pointwhere there's some more obvious need
for correction. For those whopreviously had a facelift,
(06:56):
a neck lift, the small amountof laxity may be a minor issue.
It's not what's really showing whatdecade we're in at this stage of the
game. It's relatively minor,
so some people choose to focus onvolume and skin surface at this
point, as I've already mentioned,
(07:20):
because those are the areas where moresevere findings are typically present
and the treatments are lessinvasive and have a minimum of risk.
But for people who have putoff having a surgical lift,
they will on occasion choose toproceed at this point in their early
to mid eighties. But for many folks,
(07:42):
this is really more than what they'relooking for at this stage of life.
I think it makes a lot of sense to not be
surgically lifting at thispoint, although again,
there are certainly individual exceptionsfor people who are very healthy and
active,
and I've seen some excellent resultsin folks at this stage if they're
(08:05):
properly selected andthey're good candidates.
I also noticed that you still haven'tsaid anything about non-surgical laxity
treatments. If I'mtrying to avoid surgery,
isn't this a good option for gettingsome degree of laxity improvement?
Actually, Doreen, the answer is no.
Let's look at the biology ofhow these devices work. I mean,
(08:27):
when a plastic surgeondoes a surgical facelift,
excess skin is mobilized andredrapes smoothly and the
excess is trimmed away. Somepeople respond more completely,
some less,
but it's a major change in everyonebecause we're just mechanically
removing that excess skin.
(08:48):
Non-surgical laxity treatmentssimply don't work in this
fashion. Whether the treatmentis laser, ultrasound,
radiofrequency, or someother form of energy,
the mechanism of action iscreating a controlled thermal
effect in or below theskin or at both depths.
(09:11):
And the body's response tothis biological stimulus
creates new collagenand collagen remodeling.
So collagen removal andcollagen replacement,
the response to these treatments iswholly dependent on how effectively your
body mounts a response to thestimulus of the treatment.
(09:34):
Unfortunately, as we age,this response diminishes,
which is partly why we showlaxity in the first place,
and at this point in your eighties,
it can pretty reliably becounted on to belittle to none.
So those who need laxity changethe most are least able to benefit
(09:56):
from energy treatments forlaxity. In simple terms,
you can push your skin,
but your skin has retired 10 or 20 yearsearlier and it isn't going to make a
meaningful response.
Your skin can heal and do some thingsthat we want with various aesthetic
treatments,
but laxity changes are modestwith energy treatments,
(10:19):
even when people are in theirforties or fifties at that stage,
a modest response for the modestlaxity that's likely to be
present, that's a pretty good fit,
but at the point whereyou're in your eighties,
it's just not a useful approach anymore.
Energy treatments for wrinklestypically don't show quite as good a
(10:41):
response either as when they'redone in an earlier decade,
but the response is still robustenough that these treatments are quite
useful. But laxity treatments not so much.
What about biologicaltreatments like PRP or stem cell
responses to the stem cellscontained in fat grafting?
(11:04):
That's a great question because you'dthink that if you are actually giving some
of the biological mediatorsback into the skin,
that that would make up forsome of the aging change.
But this is a very complexprocess how all of these
signaling agents,
growth factors and otherthings talk to each other,
(11:28):
and recent studies haveshown that there's a
decline in people in theirsixties and beyond in the
ability to make use ofthis kind of signaling
and create a visibleimpact on skin appearance.
So it doesn't mean thatit's useless at this stage,
(11:50):
but the response is blunted compared todoing kind of treatment in your forties
or fifties.
Okay. Dr. Bass,
can you give our listeners some partingtakeaways from this final decades of
face episode?
Absolutely. So at this stage,
some people have given upon chasing their appearance,
(12:10):
but other people are still very active.
So very variable what you'regoing to choose to do,
but in general,
we're trying to avoid surgery justbecause we want to keep it simple,
not take any unnecessary risks,
but there are individual exceptionswhere a small surgery or even a
fair size surgery can be veryuseful. But overall, again,
(12:35):
we're trying to support everything likethe little boy with his finger in the
dyke.
We're just trying to hold things togetherwith the simplest things we can get
away with. So we want to keepthe best appearance we can,
but keep it simple. However,
that doesn't always meantiny amounts. So for example,
with filler, it'snon-surgical, it's no recovery,
(12:59):
but you're not going to get away with asyringe of filler globally on the face,
you're going to be doing bigger volumes.
Surgery's only going to be for people whoare totally healthy and the procedures
should be limited, not extensive.
Remember the sensiblepriorities always safety
(13:22):
first, then looking totally natural,
then the youngest look we can produce
still, a lot of things can be done atthis stage that are very meaningful,
and a lot of the non-surgicaltreatments like fillers and basic
skin laser treatments like IPLcan make a drastic difference
(13:45):
in how old you look.
Thank you, Dr. Bass for sharingyour insight and expertise with us.
And thank you to our listeners for joiningus today to finish out our Decades of
Face series. Stay tuned,
another series Central to theCutting Edge Plastic Surgery.
We'll be starting very soon.
Thank you for listening to the ParkAvenue Plastic Surgery Class podcast.
(14:05):
Follow us on ApplePodcasts, write a review,
and share the show with your friends.
Be sure to join us next time to avoidmissing all the great content that's
coming your way. If you want tocontact us with comments or questions,
we'd love to hear from you.
Send us an email at podcast@drbass.netor DM us on Instagram
@drbassnyc.
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