When I started my career as a young facial plastic surgeon 30 years ago, dealing with the ageing process of the face was essentially limited to face lifts – as in using the knife – and mainly concerned patients over the age of 50.
At that time, I coined the phrase “Ageing-Maintenance”. At that stage, it was more of a vision or wishful thinking than a reality.
Back then, women had no way of managing the ageing process. There were no cosmeceutical products with active ingredients available, no sunscreen – conversely, it was considered that the more tanned you were, the better – and no medical cosmetic procedures other than some topical injections made by the famous Dr Morin in Paris. As one of the pioneers in the use of antioxidants, he was also the creator of the famous Meso glow, using Mesotherapie injections with a vitamin cocktail.
Fortunately, the last 30 years have been amazing. Advances in biotechnology and laser tech have resulted in collagen injections; hyaluronic acid fillers; fat transfer treatments; Botox®; plasma and growth factors injections and stem cell extracts from fat.
In addition, different types of laser treatment have been launched to treat pigmentation, vascular problems, hair removal and ageing skin. Radio frequency has also been introduced to tighten and refirm the skin. Recently, too, new ultrasound therapy has been used to tighten and shorten facial muscles, further delaying any need for surgery.
So, now that we have an amazing box with different “tools”, it is essential to be a good “artisan”. But, most important of all, we must deliver the most natural result. Our task is to restore and to help people who want to age gracefully and not to transform them completely so that they become completely unrecognisable.
A recent study by Dr Ambros in California comparing the faces of 900 people over 40 years has shown that, surprisingly, the skin does not sag and its key points do not really move over this period but the skin still ages. It gets thinner and is altered by lifestyle factors, resulting in the appearance of lines, pigmentation and loss of elasticity. These facial changes really occur as a result of sagging muscles (jowls) and the fat volume slipping downwards with them, and/or ‘melting’, to give a gaunt look.
Understanding the physiopathology of the ageing process of the face helps recognise the inadequacy of the face lifts of the 70s and 80s, which pulls the skin to its maximum without lifting the muscles and without restoring volume. Since the 90s, with the focus on the SMAS (superficial muscular aponeurotic system) and the restoration of fat volume, the face lift has addressed the real needs of the ageing face with the most natural results.
Can we avoid the face lift? A new approach
Even though “Ageing-Maintenance” was merely a concept 30 years ago, it has proved to be the best concept in ageing gracefully. The aforementioned study has shown that the prevention of skin ageing is essential starting at a younger age, while avoiding sun exposure (or getting just enough to manufacture Vitamin D) and the use of sunscreen. From teenage years and onward, it is essential to use appropriate skin care and cosmeceutical products with active ingredients from the age of 20. Avoiding ‘fast’, sugary and barbecued food will help prevent glycation, which speeds up the ageing process of the skin. It is important, too, to eat lots of fruits and vegetables.
Skin medical cosmetic procedures
To maintain, boost and revitalise your skin, from an early age you can use topical or injectable cocktails including multivitamins, hyaluronic acid, Retinol and glycolic acid. To repair loss of elasticity and to restore new collagen and elastic fibres, as a result of genetics or an unhealthy lifestyle, you can opt for plasma injections using your own growth factors to repair your skin and eventually “wake up” your own stem cells. This gives a spectacular rejuvenating boost to the skin and these injections can also be combined on a regular basis with Radio Frequency (Thermage, Pollaris Refirm, E2, Pellevé, etc.) with no downtime and greater efficacy in the long run. Fraxel laser can be used to treat pigmentation or skin ageing; ablative lasers can be used as a more aggressive approach to regenerate the skin.
Restoring the loss of volume
As proven by the aforementioned study, loss of volume in the face is a key factor in the ageing progress. In 2005, I created the first facial volumising and contouring technique (D.R.E.A.M Sculpture) using the first volumising filler by Juvederm called Voluma. This used, again for the first time, micro filling canulas. Volumising hyaluronic acids such as Voluma, Restylane and Teosyal Ultra Deep, injected with canulas, have revolutionised the way we address this problem, allowing us to restore (and sometimes increase) the loss of fat padding in the face. [Read more.] In addition, fat graft with the use of stem cells is a new and even more natural alternative to maintain and prevent the loss of volume.
Muscle sagging, gravity and excessive facial expression
We have, in fact, two types of muscle ageing: mechanical ageing, due to hyperactive expression through frowning, squinting, smiling and so on, and the natural sagging due to the fact that we have more depressor muscles than elevator muscles. Over the years, gravity also plays its part, and the overall effect is of things “going south”! The sagging muscle phenomenon is the major reason why lifting treatments have been created, especially for the neck.
The Botox® miracle
Renowned for relaxing frowning or horizontal lines of the forehead and “crows feet”, Botox® should also be used from an early age to reduce the strength of the depressor muscle of the jowls and the neck, therefore considerably reducing the need for a neck lift. [Read more.]
The ultrasound miracle
Just recently, a new technology based on High Frequency Ultrasound, ULTRALIFT, has been FDA approved for brow lift, face lift, neck lift and décolletage treatments. The ULTRALIFT (exclusive to French Cosmetic Doctor Ltd.) features revolutionary, no downtime face and neck lifting technology. It harnesses the power of gentle yet powerful ultrasounds to lift not just the skin but also the deep muscle layer underneath (SMAS), which was previously only reached by surgical lifts. During the treatment, warm pulses of ultrasound energy are delivered deep under the skin, causing the muscle layer to contract. At the same time, the heat stimulates your skin to produce its own, fresh new collagen. This makes the skin firmer, brighter, tighter and more elastic. [Read more.]
Silhouette Soft Threads
To complete the non-surgical new lifting procedures, the latest Silhouette Soft Dissolvable Thread Lift, launched in our clinic last year, has been an exceptional tool to finalise and refine our approach to natural and non-surgical face maintenance. This is a new treatment with a double lift and regenerating collagen effect. Its component, Poly-L-Lactic acid, is entirely re-absorbable and has been used for many years without side-effects. It is a tailor-made treatment for flabbiness of various areas: mandible (jaw line), neck, malar area (cheek bone) and eyebrow. It gives an immediate natural lift effect in a 30 min procedure, with a progressive restoration of lost collagen and a long-lasting effect for up to 18 months. [Read more and watch a video of the treatment.] Silhouette Soft can be used as a standalone treatment or in conjunction with Botox®, Volumising Fillers and the new ULTRALIFT ultrasound, to achieve the best natural lift possible. After 30 years, my vision has finally become a reality. It is definitely possible to say that if you follow my Ageing-Maintenance concept, using the different techniques according to your individual needs – at your own pace, without any risks or side effects and with almost no downtime – you can age gracefully, whilst still looking like yourself, and keep the need for surgery at bay. Dr. Jean-Louis Sebagh London, September 1st 2014 Read more about all the non-surgical treatments available at Dr Sebagh’s London and Paris clinics for face and body, and hair transplants. Read more about the Dr Sebagh London clinic team.