Latest / Alabama The Beautiful: The Eastern Shore Cosmetic Surgery Podcast / Sixty-ish: Best Anti-Aging Treatments for Your 60’s
Transcript
- Announcer (00:02): You are listening to Alabama the Beautiful with cosmetic surgeon, Dr. James Koehler and Kirstin Jarvis. Kirstin (00:08): Hey Dr. Koehler. Dr. Koehler (00:09): Hey Kirstin. Kirstin (00:11): You want to know what we're talking about today? Dr. Koehler (00:14): Tell me. Kirstin (00:15): Well, we covered how to prioritize your skin in your thirties, forties, fifties. So now we're getting serious. We're going to talk to the sixties-ish people. Dr. Koehler (00:28): Alright. Let's do it. Kirstin (00:30): In your sixties, are non-surgical treatments still a big part of the anti-aging treatment plan? Dr. Koehler (00:37): They play a role still and there's always going to be people that are never going to want to take a surgical route. So it's not like these things are not available. I think the expectation of what they can achieve starts to change. So you're going to see a greater effect from things like Botox and fillers when you're in your forties compared to your sixties. Sometimes people will get fillers or Botox in their sixties and they're like, well, it's just not working like it used to, I'm like, well, it's not that it's not working, it's still doing what it was doing before, but there's changes that have occurred to the skin and the underlying tissues that are not corrected with these treatments. And so you're not going to see the same kind of positive benefits that you would see if you did that same treatment when you were in your forties. So people in their sixties, that's definitely when we start, no question. It's like if you're wanting to really see something much more significant in terms of changes, we've really got to discuss these surgical options. So yeah, it tends to be a combination of when you get into your sixties replacing volume and repositioning sagging tissues and you really need to kind of do both. If you try to just do one, you start getting to look kind of funny. It doesn't look right. Kirstin (01:59): Well, let's talk about fat grafting a little bit because that's something that's a little bit newer to me and not widely discussed, I don't feel like when just lay, people are talking about facelifts or facial surgery. So you do some fat grafting with a lot of facial procedures. Whose fat do you use? Where do you harvest the fat? Dr. Koehler (02:19): Well, everybody wants to be a fat donor. Everybody I ever talked to said, can I donate my fat? You can use it for other, you have to use your own fat. You can't donate it to anybody else. So it comes from you. The typical areas we're getting it from is lower abdomen or outer thighs, just depends. But really just wherever. It's a convenient way to get to the fat. And we're not taking tons of fat when we're fat grafting somebody's face. It's not typically high volumes. It's like maybe two milliliters in the lower eyelid, maybe three milliliters in a cheek or more. But it's small volumes and it's strategic in where it's placed. But basically we liposuction the fat through not an incision, but like a little needle puncture and we harvest it with 10 cc syringes. And then that fat is typically centrifuged and we try to take off all of the fluid and the oils and just retain the fat cells. Dr. Koehler (03:19): And then a lot of times too, well, I shouldn't say a lot of times it depends on the patient, but we also will sometimes combine that with platelet rich plasma. So we can take your blood and spin that down and get the growth factors out of the blood and combine that with the fat that we've harvested to try to get even better take of the fat. And so we add the volume, this fat back into the areas where there's deficiencies related to age. So in let's say people in their sixties, something we may see is some wasting in the temporal area here, there's a fat pad and there's a muscle here. And so you sometimes see people there where it just look kind of like hollow in their temples. Now they do make actual implants for that area, but a lot of times we like to use things like fat. It's much more natural and it's a lot easier to do. So yeah, we harvest the fat and we can inject that. And we do that usually in conjunction with some other procedure like a facelift or a brow lift. Kirstin (04:22): So it sounds to me like I would rather have fat anyways versus filler if I had the choice. Dr. Koehler (04:28): Well, there's certainly advantages. So the big advantage to fat is first of all, it's your own body. So you're not going to have any allergic reactions or nodules or inflammation typically related to it, your own body. The biggest advantage is whatever fat is going to stay will be long lasting. Now, not all of it will stay, that's the only downside. And we don't typically overcorrect or if we do, it's very minimal because we really don't know how much is going to stay. So if you don't know how much is going to stay, you don't double the fat and go, oh, I know half of it's going to go away, and then it doesn't and then it looks weird. So we just put in what we feel like we need. And sometimes people might need another session of fat grafting if it was really indicated. But the big advantage is what fat stays is going to be long lasting. And so unlike filler where you have to maybe add to it every eight months to a year or however long depending on your needs, the fat is going to be longer lasting. Kirstin (05:31): Love it. Love the fat. All right, well, we don't really need to have a big long discussion on Botox and fillers because what we talked about in the fifties episode mostly applies here. It sounds like as well as skincare, you want to make sure that you're using sunscreen and retinol or Retin A and microneedling is definitely going to help produce collagen and stimulate that collagen growth. But let's talk about lasers, at least here on the Gulf Coast. We may want to treat sun damage continued into your fifties and sixties, but would you recommend something like you would perform or something like our aestheticians would perform? Dr. Koehler (06:14): Well, I mean, typically people in their sixties are going to have more significant sun damage photo age skin because the photo damage that you get is not what you did last weekend or last month. It's what you did when you were in your twenties, in your thirties, in your forties. It's a cumulative effect. So if you talked about, oh, when I was in my twenties, I did the Betadine and baby oil and whatever. Kirstin (06:43): What? Dr. Koehler (06:44): It might've been good at the time, but now you're going to pay the price. So it's a cumulative damage that occurs. And so yes, the photo damage to your skin, the fine lines and wrinkles, all that stuff is going to be greater in your sixties. And so the more aggressive treatments are definitely going to be something we're going to be considering more in your sixties. So yes, you can do the office-based lasers and microneedling, but for many people it's going to be a combination of surgical procedure to elevate the tissue. So a lower face and neck lift, a brow lift, but then something that addresses the skin itself. And that's going to be CO2 laser resurfacing. Now you mentioned we're here on the Gulf and that does play a role. And so we do have to really look at lifestyle when we make this decision because there's certain things that just make you a non candidate for CO2 laser, and that's number one, if you're a smoker and you're not going to quit, well, we're not going to do laser resurfacing on you. Dr. Koehler (07:40): It's just pointless. And the second is if you enjoy being out in the sun and you're like, well, I, that's what I do. I'm just going to keep doing what I do. Again, it's not a good idea because when we do CO2 laser skin resurfacing, we're stripping off the top layers of the skin and that is going to make your skin even that much more sensitive to the sunlight. And unless you're really protecting your skin with at least a 30 sunscreen and hat and all this stuff. And if you're not willing to try to purposely try to keep yourself out of the sun, if you get laser resurfacing and go out into the sun, you can potentially end up with significant hyperpigmentation of your skin, poor healing. It's just not, it's not going to look good. So Kirstin (08:26): It could be worse afterwards if you don't take the proper precautions, is that what you're saying? Dr. Koehler (08:30): Yeah, if you're not taking care. So it's like your skin is more at risk for sun damage after the laser resurfacing. So if you're not willing, if you're like, I'm, I like to be outside, I might put sunscreen on, I might not, then you're not a candidate for laser resurfacing because you're much better off in those cases to do. You might not get the same benefit, but it's much safer to do something like radio frequency microneedling where you know what, yeah, you can go out in the sun mean, but you're not going to make it worse. Yeah. But the more aggressive treatments typically are going to be used as we get older. Kirstin (09:05): What are the most common surgeries that you do for people in their sixties? Dr. Koehler (09:09): Facial surgeries? Yeah, it's going to be brow lifts, definitely eyelids, upper eyelids, lower eyelids and lower face and neck lift, that combination or some variation of that. Kirstin (09:20): Are there pros and cons to combining certain facial surgeries or would you rather do them all together or do some people separate them? Dr. Koehler (09:27): Well, it depends, but yeah, there can be advantages to doing them together, especially as you get older. So when you do a lower face and neck lift, all these sagging tissues are being lifted up. Well, the more sagging or the more age that we're trying, like the reversing that we're trying to do, this is getting lifted. Well, it's going to, the incision starts in the hair, toughed in front of the ear, your sideburn, and it goes into the crease of the ear and back around the ear and into the hairline, but it has to stop somewhere. But if we lift it up here and now we've lifted this up, now we've got some bunching that can occur in this area here. And so I see that typically even in patients, let's say our early fifties, they don't necessarily need a brow lift, but they still will have a little bit of bunching right here. Dr. Koehler (10:21): It just sort of happens as this is getting, because the main vector is more vertical. It's not pulling back this way. It's more of an upward lifting. And because of that, there can be some bunching here. So when this bunch is up here, if we do a brow lift at the same time, now we kind of limited some of this bunching that occurs here. And so on some of the older patients where the amount of lifting is going to be greater than the benefit of doing a brow lift at the same time, is there, whereas, I mean you could separate it, but now all of a sudden, this looks great and this doesn't look so good here and you want it to match. Kirstin (10:58): Let's break it down. What procedures help with each of these concerns that people have in their sixties? So fine lines and wrinkles. Dr. Koehler (11:06): What is helpful for fine lines and wrinkles in the sixties? Well, Retin A obviously, but it's not going to really do much in your sixties. You should be doing that all along, the radio frequency microneedling. Some of the lasers like the Ian lasers in the office are fine, but CO2 laser skin resurfacing is for the static fine lines and wrinkles. That's the gold standard treatment. Kirstin (11:28): What about jowling and droopy skin? Dr. Koehler (11:31): Definitely a facelift. No other treatment for jowls. Stay away from the thread lifts. I'm not a fan of thread lifting at all, period. Tried it many years ago. It was under, I think we talked about this in a previous episode, but if it really worked and we really didn't have to do surgery on people and we could correct all these issues with threads, I promise you we would be offering it because we like minimally invasive, we like low risk, we like happy patients, basically. If we can do something that makes people happy, we want to do it. That's why, I mean, we do Botox. We're a surgical practice, but we love Botox. Why do we love Botox? Because it works and patients are happy and they like it. But what I tell you is threads don't work. It doesn't last. And generally speaking, if patients are happy, it's for a very brief period of time because it just doesn't last. And unless you do surgery and you know what it takes to actually lift these tissues, you realize that there's just no way that these threads can actually do anything. And so anyhow, don't waste your money, save it, and get the proper procedure, which is a lower face and neck lift. Kirstin (12:34): What about puffy bags or dark circles under the eyes? Dr. Koehler (12:39): Well, a lot of times that's from herniation of the little fat pads surrounding your eye. Sometimes people say, oh, things like allergies and other things can maybe exaggerate that. But at the end of the day, those fat pads are bulging and the bulging of that fat, mainly when the sun is shining or the lights above are coming down, it creates a shadow underneath the bag and it looks like pigmentation. But most of the time there's no pigment there at all. It's really just a shadow that's created because of the contours. And so the way we improve on that is to get rid of the bag, remove those bulging fat pads, and then oftentimes to fill in the hollow area with fat. And by sort of taking down the hill and filling in the valley, we've been able to get rid of that shadow and it gives a more youthful appearance. Kirstin (13:31): Okay. All right. Last thing, what about nasal labial folds or smile lines? Dr. Koehler (13:37): Well, dimples and smile lines, or are you talking about nasal labial folds alone? If you've got dimples, you can't put filler in there or fat in there. I mean, it's just those, Kirstin (13:49): No, you should keep your dimples if you have dimples. Dr. Koehler (13:50): Yeah, you should keep your dimples. I agree. But the nasal labial folds a facelift in particular, a deep plane facelift will help soften those nasal labial folds. But the thing that I always tell people, the treatment objective for a lower face and neck lift is not to completely efface these lines here. And if you go back historically or not historically, but if you look at some people who have that really pulled or odd appearance, it's typically because somebody's trying to really, they're like, oh, I want these lines gone. And the surgeon is putting too much force to try to really get that corrected. And in doing so, they give people their mouth has kind of a stretched or odd appearance. And these folds, although they may be gone, they look like they're in a wind tunnel. And so the goal is not to, if you look at even people in their twenties, the, there's lots of people in their twenties that have a nasal labial fold. Dr. Koehler (14:55): Now, it may not be as deep as somebody in their sixties, but the goal is to not eliminate it. But the point is a lower face and neck lift will address that to a certain degree, but the goal of the treatment is not to get rid of that. So you might need to add some fat in there to help soften it. So a combination of treatments. So we're going to try to fill in a little bit, and we're going to hopefully get some tightening with the elevation of our lower face and neck lift and get that improved. Kirstin (15:23): Okay. Anything else to add for our friends in their sixties? Dr. Koehler (15:28): Yeah, I mean, I actually have an example that I use in consultations, but sometimes the volume changes and the volume loss that occurs with age or weight loss, we've talked about it before with weight loss, but it can occur with age as well, can be so significant that sometimes what we're wanting to achieve with fat grafting, we just can't get. And I have this patient that saw me and she came and she goes, well, I don't want a facelift, but I'd like to look younger. And when I looked at her, the most striking thing, yes, she had lots of static lines on her face, but she'd really lost lots of volume in her malar and sub malar region. So this whole cheek area was just sort of deficient. And in addition to it being deficient, it also had lots of lines and wrinkles over it. Dr. Koehler (16:17): And I said to her, well, if you don't want to do a facelift, I said, what you really need is volume. And in somebody who had a much less volume loss, I would recommend fat grafting. But in your case, the volume loss is significant and I want something predictable that's going to stay. And so we actually used a cheek implant. And so this lady who was in her sixties, or she was probably in her late sixties, we did cheek implants and some fat grafting. And I will say that it is a pretty striking before and after result. And oftentimes people are like, oh, what did she have done? Was that a facelift? I'm like, Nope, that was cheek implants and a little bit of fat. And it made a huge, huge difference. So again, we've talked about it before earlier in our discussion, is that we have to correct volume loss. Dr. Koehler (17:11): That's part of treating aging changes in the face, but we also have to reposition tissues back into their natural location. And you can achieve results with either one, but you can definitely achieve the maximum results when you address both of those things. And as somebody once told me, if you're born a grape and you die a raisin, you don't make a raisin a grape by tightening the skin on the raisin, you got to add some volume back too. So it's a combination of both. Anyhow, that's what we really want to try to achieve is both. Kirstin (17:44): You always have the best analogies. Dr. Koehler (17:48): Okay. Kirstin (17:48): You do, okay. Is that all you got? Dr. Koehler (17:52): Well, I will say, so one other thing that I guess I would probably want to tell people, it doesn't matter if you're in your fifties or your sixties, but when we do these surgical procedures to address some of the aging changes, and I mentioned in our podcast on the fifties, is that it doesn't freeze you in time. Okay? So always remember that these procedures, they can turn the clock back a bit for you, but you continue to age the moment this procedure is done. So again, how long the procedure lasts will kind of depend on how you age. So you look at two classmates of yours from high school, and you might look at people in your class and you're like, golly, we're the exact same age, and one person may look so much younger than you, or somebody might look so much older than you. Dr. Koehler (18:40): We age differently. So we don't all age at the same rate. And some people are just lucky in that regards. But the point is, is that the procedures don't freeze you. It's also hard to compare. You might go, oh, my friend had a facelift and she's had it for five years now, and she's still looking great. But again, you can't compare just every two people because again, we age differently. But what I would add is if you do get something like this done, it's not a got my facelift, done. I mean, if you really want to get the long-term benefits, the other nonsurgical things which we did talk about, which was maybe some radiofrequency microneedling, maybe some photo rejuvenation skincare products, all of these things, that's the maintenance part of it. And certainly you don't have to, but if you're really wanting to get the long-term benefits of these things, you should be doing some of these things to maintain the collagen stimulation and to help keep this result as long as you can. Kirstin (19:45): And maintain the investment. Dr. Koehler (19:48): Yeah, exactly. Kirstin (19:48): Meaning if you're going to spend that much time and money on your face, make your results last. Is there a surgical procedure once you get into your sixties that you start targeting men or men come to you for certain things when they get a certain age? Dr. Koehler (20:05): So we don't do as many lower face and necklace on men as we do on women, but we definitely get them. One thing I will say that for men, one of the biggest concerns that they come in with is they don't like the neck. So they're not so concerned with their cheek. And a lot of times they're not even really bothered too much by jowling depending on the guy and the severity of it. But really the thing they don't like is the neck. And so I will say there is a procedure, and we don't do it super often, but there are cases that we do this where yes, you can address the neck by doing a lower face and neck lift, but some people are like, is there something easier that I can do? And I'm like, yeah, there is. It's called a direct neck lift. Dr. Koehler (20:54): It involves putting an incision under the chin, and it takes kind of a zigzag approach along the anterior part of the neck, and it ends just before the sternal notch here. But you actually can excise all of that skin and you can tighten up the muscle and you can pull everything and get it looking pretty good and tight. And yes, you do have a scar that's on the anterior part of the neck, but so sometimes men actually prefer that, believe it or not. And part of the reason is that most of that incision is hidden under the chin, and only a little bit is visible here. And because men typically wear their hair short, and sometimes in men too, because we can't, we don't want to pull hair bearing skin onto the tragus, which is the little pointy part on your ear. So a lot of times the incision will be in front of the ear and it'll be along the hairline. Dr. Koehler (21:47): Those incisions sometimes can be noticeable in men that wear their hair very short. There's definitely things we can do to try to minimize that. And I still think the preferred way to lift the lower face and neck is definitely a deep plane facelift. But there's definitely situations where I've done an anterior approach, direct neck lift for men and achieved their goals with a very limited downtime, like because we're not having to elevate the whole side of the face here and here and the neck. We're able to do it, it's a shorter procedure with a quicker recovery. And for some people, that is a really good option, and I've had some very happy patients with that procedure. Kirstin (22:29): Now, when men get a little bit further up there in their years, such as in their sixties, do you typically see them doing Botox or is it mostly surgical? Dr. Koehler (22:40): I would say definitely more surgical than Botox. I don't know, I think guys probably, they don't fight it as hard as women do when they start getting older, they like, yeah, I'm okay. Kirstin (22:54): That's true. Dr. Koehler (22:55): They accept a little bit more of the lines and wrinkles. Women, they fight it a lot harder. I mean, it is very individual, but I will, I've had men in their sixties that are still working full time and they're like, look, I want to compete in my market and I want to look as good as I can look because I'm in business or sales or something like that where I'm in front of people. So you definitely have men that have their reasons, and sometimes people are, their wife has died or they're divorced or whatever, and they're back on the market and they're being single at 60. So it's like there's reasons people want, they want to do these things. Yeah, I mean, we definitely, again, we see more women than men having it done, but there's definitely lots of men that do this. Kirstin (23:44): As they should. Do you have a burning question for Dr. Koehler or me? You can leave us a voicemail on our podcast website at Alabamathebeautifulpodcast.com. We'd love to hear from you. Thanks, Dr. Koehler. Dr. Koehler (23:58): Thanks, Kirstin. Kirstin (23:59): Go back to making Alabama beautiful. Dr. Koehler (24:01): All right, take care. Announcer (24:02): Got a question for Dr. Koehler? Leave us a voicemail at Alabamathebeautifulpodcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope, Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram at Eastern Shore Cosmetic Surgery. Alabama the Beautiful is a production of The Axis, theaxis.io.