Latest / Alabama The Beautiful: The Eastern Shore Cosmetic Surgery Podcast / Fifty-ish: Best Anti-Aging Treatments for Your 50’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 (00:10): Hey, Kirstin. Kirstin (00:12): What's up? Dr. Koehler (00:13): Not much. Kirstin (00:14): Would you like to know what the topic is for today? Dr. Koehler (00:17): Sure. What's fire away? What do you got? Kirstin (00:19): Well, a few episodes back we talked about how to best care for your face in your thirties and forties. So today we're back to talk about your fifties. Dr. Koehler (00:30): All right, fifties. Kirstin (00:32): What do you know about that? Dr. Koehler (00:35): Wouldn't you like to know? Kirstin (00:38): Okay. So for people in their fifties, are you still preventing or is it about reversing? Dr. Koehler (00:46): Well, I don't know that there's anything such as reversing, but I mean, you're certainly maybe considering more aggressive treatments in your fifties, but you still, I mean, the preventive thing is ongoing, so prevention is ongoing. It doesn't matter what your age is. I mean, you still put sunscreen on if you're 80 or if you're 30, you should be putting that on. Maybe some of the modalities might be a little different, but you're always still trying to do a little bit of prevention, but you can't avoid age. It just keeps coming. And I guess really the decision making process starts to change when you get older. For some people, I mean, you either accept the aging as it is, or if you're coming to see somebody like me, you're like, okay, I'm not exactly happy with what's going on, so what can I do? So yeah, we start talking about some different options, and surgery is definitely more on the table when you start getting in your fifties. Kirstin (01:39): Okay, so the last few episodes, you gave me some rapid-fire answers for the thirties and forties. So how about for the fifties? What are some things we should do every day, every month, or few months or every year? Dr. Koehler (01:56): Well, I think again, the prevention things are washing yourface with a good cleanser. You're going to use maybe more prescription strength type products rather than maybe just over the counter products. There's certainly a number of them, and that's something that be discussed between you and your doctor as far as what's going to be best for your skin type, because whether you have oily skin or dry skin or whatever, there can be variations of what is going to be best to use on your skin. But RetinA, if you can tolerate them, are always a good product to help keep that kind of glow to your skin, to keep that top layer of dead skin cells kind of compact and to kind of, again, give your skin that youthful glow, but hopefully you've been using it and you can tolerate it, but you would continue to use that through your fifties and into your sixties as well. Dr. Koehler (02:44): Then as far as in office type stuff, well, depending on your situation, if you have photo damaged skin, well then you might be considering in office laser treatments, photo rejuvenation. Sometimes some of the lighter to medium depth chemical peels can be also a good thing to kind of keep your skin rejuvenated. And of course, something that's really big now I think in most offices is radio frequency microneedling or plain microneedling, and that's something that I think is good. And the frequency of which you do it, I mean, it's going to depend on your budget and also depend on your needs. But the lasers are going to target pigment. Some of the lasers we use, if you're using a fractionated CO2 or there's some other lasers, we use Erbium, where they can actually help skin texture and tone. And then the microneedling is also something that will help skin texture and tone. So those things can all be done in office setting. The radio frequency microneedling, we're typically doing a series of treatments, usually three treatments spaced about six weeks apart. And then people go like, well, is it all, once I've done those three treatments, am I done? And the answer to that is, well, you can be, but you're probably going to want to touch it up. Maybe you do a treatment or two in another, maybe eight months to a year. So again, the frequency will depend on your needs and your budget. Kirstin (04:09): So as far as skincare, when you're 50 ish, or you already said a good Retin A would be great to continue into your fifties, are there any other must haves? Dr. Koehler (04:21): Again, it just really depends on your skin because if you, let's say you've had some hormonal changes and now you've got some hyperpigmentation or maybe it's hyperpigmentation related to a sun exposure, well then you might be wanting to use a prescription skincare product in addition to Retin A that contains something with a hydroquinone in it, which is a bleaching cream. And I say bleaching cream, it really doesn't bleach your skin, but it does slow down the production of melanin. And so those cells that are overproducing, melanin are not going to be producing as much, so it'll help lighten those areas of hyperpigmentation. And then there's some skincare products that contain some growth factors, which some feel is going to help give your skin a more youthful appearance. But the hydroquinone are going to be more fifties and sixties, whereas let's say the vitamin C type products are going to be maybe more for people in their thirties and forties, the antioxidant type products. Kirstin (05:18): So also you mentioned products with growth factors in them. So growth factors would help maintain your good skin health after procedures like microneedling or lasers or something like that. Can you continue them even when you're not? Dr. Koehler (05:34): Yeah, yeah. There's products that we have Kirstin (05:36): Just in your regular skincare routine. Dr. Koehler (05:37): that you can use, your regular skincare regimen. Yeah. Kirstin (05:39): Okay. What about Botox and Dysport? Is it too late when you get into your fifties to start that? Or is that something that we should have been doing before our fifties? Dr. Koehler (05:49): Well, we're trying to put everything in these categories that you said, what do we do in thirties, forties, fifties? But it just depends on the person, because I see people that are in their fifties that have never done Botox, and they've got really good skin, and yes, they'd benefit from Botox, but I see other people that I wish they had started Botox 10 or 15 years earlier. So again, environment, genetics, habits, like smoking, all these things, your diet, I mean, all of these things combine to form what is going to happen with your skin and the aging process. So although we're talking in general terms about an age, yeah, Botox can be great to start in your fifties. Now for some people, they need to start much earlier, like twenties or thirties. Typically it's going to be thirties and forties, but some people benefit even earlier like we talked about. Dr. Koehler (06:43): But definitely it works on dynamic lines, and you will always have dynamic lines and they get deeper as you age. So the lines that you have on your face at rest are not going to improve with Botox. So I think the expectation, if you're in your fifties and you're just now deciding that I want to do Botox, if the communication between you and your doctor is not good, and you may go in with the understanding, I have wrinkles on my forehead that I just decided now I want them to go away. And you go and get Botox and you look in the mirror two weeks later and you're like, all these wrinkles are still there. And I would be like, yes, those would still be there. What is going to go away is the lines that you form with motion. So if you form really deep lines when you scowl or really deep creases in your forehead, when you raise your brows, it will soften those. But the lines that you have when you're completely relaxed and look in the mirror are still going to be there. So all I would say for people in their fifties or sixties is when they're doing Botox that realize what the expectation is. This is not something like, it's not spackling, it doesn't fill in the cracks, it just prevents the dynamic lines. Kirstin (07:55): Is there a certain target or certain number of units that you see people who are 50 ish getting, or does that again depend on the person? Dr. Koehler (08:03): Yeah, men take more units than women generally speaking, but that's not always true. And when I do Botox on people or Dysport on people in their, let's say, thirties and forties, typically a lot of times we're using doses that are lower than what let's say the FDA recommended starting dose would be. But once we start getting into the fifties, we're typically using the recommended starting dose or higher. But it just depends. It depends on the strength of the muscles. It's an individual thing. Kirstin (08:37): Okay. What about fillers? Is filler an option in your fifties? Dr. Koehler (08:42): Yes, but I think the thing that maybe changes is again, the expectation. So as we age, we do tend to have some atrophy of the fat pads in the face. So we start losing some volume and what volume we have maybe also is now starting to descend. So maybe when we're doing filler in our thirties and forties, women are getting their lips plumped up, let's say. But when we start talking to women in their fifties, they're wanting to put filler in their nasal labial folds and marionette lines and maybe their cheeks. And I guess, I don't want to say the danger, but the concern that you have when you're starting to put filler in people in their fifties and sixties is that number one, if you're going to do the filler, you got to make sure you use enough filler because these syringes only contain one milliliter. Dr. Koehler (09:39): And so five syringes is a teaspoon, and a teaspoon is not very much. So if somebody comes in and they want to do these nasal labial folds and they go and then marionette lines and they're like, I want one syringe, well, I would say that's not going to really cut it. And so you're better off just not even spending your money if you're going to only do one syringe. So if we are really dealing with some volume loss, the amount that we're going to use is going to be greater. But on the flip side of that coin is the fact that you got to be careful, as we start getting older, what happens is people may come in and they go, okay, I'll do four syringes if that's what you recommend, four or six syringes, whatever it is. And we'll do that. And then maybe the person will come back in three, four months and they're like, you know what? Dr. Koehler (10:22): I think I need more. And they slowly start just adding more and more volume. And they're definitely can come a point where, like you get used to looking at yourself in the mirror, and so you had this filler, and I'll see this in people, they're like, oh, my lips are already gone down and it's only been four weeks. And they come back and they're like, I need more filler. You're going to have to put more in there. And I'm like, your lips look pretty big. They're not as full as they were. Okay, well, we put more filler in. But you start to forget what you looked like before. And over time you end up sometimes just putting, people can get crazy and start putting too much filler in. And that's when we start again, we start to look odd and people think, oh, if I do non-surgical things or these minimally invasive things, I can avoid looking kind of odd or weird. Where in fact, you can actually have the opposite. If you did something like a facelift, you could end up with something that's much more natural appearing than trying to camouflage it with a bunch of fillers and have volume in areas that maybe you naturally never really had in the first place. So Kirstin (11:29): What might you tell someone if it's time to start looking at surgery versus filler? Like say they can't come in and say, yes, I want five syringes of filler, but they're really more of a surgical candidate. Is that a conversation that you then have or not really until they approach it first? Dr. Koehler (11:46): Well, I feel like if people are coming to see me, it's my job to recommend options. I mean, what I'm not going to do is if they come in and they go, oh, I'm concerned about whatever, something on my hand. I'm not going to say, Hey, do you know you could use a facelift? But if we're talking about their face already, and I'm like, okay, look, the filler's not going to be what you need, you might really start to consider, you're getting to that age where a lower face and neck lift or a brow lift or an eyelid surgery might be more appropriate. And some people are like, oh, no, I'm definitely not interested in surgery. And I always, that's fine. We're not here to sell stuff to people, but we are here to make sure they understand what their options are. So at that point would be like, okay, well look, if you ever change your mind and want to discuss it, I'd be happy to show you pictures and explain what you can achieve with that. And occasionally people will say something like, oh yeah, but I don't want to look odd or weird or unnatural. And that's where we can have good discussion because I agree, and I think we've all seen some of these people over the years where you're like, oh gosh, what did they do? But it doesn't have to be that way. And so you can achieve something that's natural appearing and appropriate, and it can be surgical. So again, discussion you need to have with your doctor. Kirstin (13:06): So going back to skin texture, chemical peels in your fifties, is that an ideal time to do something like that? Dr. Koehler (13:15): Chemical peels come in different depths. The superficial chemical peels are the kind of peels that let's say aestheticians do, but they also have medium or deep chemical peels. Now, I don't do deep chemical peels cuz I have a laser and I feel like it's more controlled, but they both can achieve the same thing. And these deeper peels, that's for more aggressive resurfacing for heavy lines and wrinkles at rest, lots of photo damaged skin. And for me, those patients go to sleep for this because it's a much more aggressive peel and it's not comfortable. So I wouldn't put them necessarily on the same level. But people talk about doing fraxel or fractionated CO2 in the office setting, and you can do that with topical anesthetic and you do CO2 resurfacing, but it's not really as deep or as aggressive, and it's an office procedure. And same thing with a medium chemical peel, it's not as deep appeal, and your skin may look kind of bad and brown and flake and peel off over several days, but it's not really deep. So yeah, those peels can be done even in your fifties. But typically, again, the depth of the peel is definitely going to be a correlation to your age to a certain extent. So you would never consider doing a deeper chemical peel or laser resurfacing on somebody in their thirties unless we're treating something like acne scars, which then we might, but they could do maybe a medium depth peel in their thirties. And somebody who's just wanting to maybe make their skin feel a little bit better, but they're not wanting the downtime of the laser or a deep peel might do a medium depth peel. So I think it's totally appropriate, but again, depends on the person, depends on the skin problems we're dealing with, and also the level of correction that the patient wants. Kirstin (15:10): Okay. Well, I'm excited to talk about the next thing because we got a new, I don't want to call it a toy, but we got a new fun microneedling machine. Dr. Koehler (15:20): Yeah, we do. Kirstin (15:23): So what are some things that people in their fifties might complain about that microneedling could help with? Dr. Koehler (15:29): Well, our particular microneedling device that we got, the SYLFIRM X is the brand that we just got, and I'm very excited about it. We had Vivace, which I was also very excited about, I thought it was a great device. I think this is kind of an upgrade now. The newer device has got some higher energy levels. It's also got a little bit more control over the depth. We can go shallower and do some certain things like we can treat lower eyelids, whereas before these other devices, you had to be a little more careful. You couldn't really treat lower lids, but you can safely treat lower lids with this new device. Typically, all the radiofrequency microneedling devices, the goal is to stimulate collagen formation, which is going to help with fine lines and wrinkles and help with that skin texture. But this device has some settings that we can sort of change and we can actually potentially treat rosacea and treat some hyperpigmentation problems with it. And it's also a very safe device in terms of if we're using it for collagen production, we can use it on all skin types, African-American skin, Asian, Indian, it doesn't matter, your skin type. You can safely do this and not have the concerns of post-inflammatory hyperpigmentation, which can sometimes be a problem with certain devices. Morpheus is a great device, but that's a device that sometimes can potentially have those issues on certain skin types. So Kirstin (17:01): Radio frequency, microneedling, something that can help tighten skin? Dr. Koehler (17:06): I don't like to use the word tighten per se. I mean, all of these nonsurgical tools I think can again improve skin texture and tone. But what they're not going to do, so if somebody comes in and they've got these platysmal bands and some laxity in their neck and they're like, okay, I want to do microneedling to tighten my neck. I mean, yeah, the skin does improve, and let's say it's going to contract a little bit and we'll call it tightening, but it's minimal. It's going to help with the collagen, it's going to help the appearance of the skin, but the skin is directly attached to other things. There's muscles in your neck, and if those muscles have developed laxity with age, you're not going to get a smoothing appearance of the neck unless you tighten and reposition those muscles, which is part of a lower face and neck lift. So that's how you can go from having kind of these sagging banded necks to a smooth contour. It's because it's not what you, it's really the skin kind of follows the tightening of the muscle. So when you improve the position of that muscle, the skin follows and the contours improve. So yeah, I don't really like to use, tightening is a word, but sure, we'll say there's an improvement in this tightening of the skin to a mild degree. Kirstin (18:30): Okay. All right. So lasers we already mentioned can help with sun damage, redness, stuff like that. Do you want to elaborate on any of that? And also, we have the Resurfix, so if you want to speak on that. Dr. Koehler (18:47): No, I don't want to speak on that. I'm just kidding. Kirstin (18:50): Well, fine. Dr. Koehler (18:53): No, I mean, yeah, there's lasers that are office-based that again, can treat pigment, some will, so some lasers, the chromophore or the target of the laser is pigment. And so certain lasers will, depending on the energy and whatnot, we can treat reds and browns and those kinds of things in the skin. So that would be the photo damaged skin. And then there's other lasers where the chromophore might be is water. And so those lasers, they work differently. They're not going to do anything to pigment, but they're going to deliver some energy, which is again going to stimulate collagen similar to radiofrequency. So a lot of these, what we can do with some of these office-based lasers is very similar to what we're achieving with radiofrequency microneedling. And I dunno, I guess there could be some argument over like, well, which is better? And sometimes a combination of them is helpful, and some people just respond better to one treatment than another or can tolerate one treatment better than another. So I hate to, it's hard to compare all the devices head to head, but in general, the radiofrequency microneedling is mainly going to be for collagen production, although I mentioned it can help with things like rosacea, pigmentation, but we have these other lasers that we tend to use targeting just directly for pigment. Kirstin (20:25): Well, let's talk about surgery because that's our favorite. You already talked about how a neck lift can help with the platysmal banding. Are there any other common surgeries that you do with people that are in their fifties? You kind of do everything. People in their fifties even get breast augmentations and tummy tucks and BBLs? Dr. Koehler (20:47): Yeah, I mean, there's not an age for, so any of the body procedures, I mean, it depends on your health. I mean, I've done tummy tuck on 70-year-olds. So it's not like there's not an age. The typical age is going to be women who've just finished with their kids, they finally have gotten to a point in their life where they can take that kind of time off for recovery and they want to do that sort of thing. So that's when the breast lifts and the tummy tucks and stuff like that tend to occur. And typically, once people are getting into their fifties and sixties, I would say yes, there's more of a shift towards facial procedures or there's definitely an increase in the number of people seeking out facial procedures. Whereas we're doing rhinoplasties and ear surgery, that's at any age, or it's typically younger patients. You're not seeing 50 year olds typically coming in saying, I'd like my nose done. They're more concerned about their necks and other things. But yeah, I think the things that are common in fifties and sixties are going to be brow lifts, upper eyelids, lower eyelids, facial fat grafting, lower face and neck lift, maybe a lip lift. Kirstin (21:53): Does it take longer to recover when you're a little bit older and have a procedure like that? Dr. Koehler (21:59): It can, but I've seen that vary so much. I mean, we just did a facelift on a lady, I don't know, we put her on her Instagram not too long ago. And I mean, she's in her sixties and she was doing great next week, but she's also very active. And so the biggest hindrance to doing these procedures is going to be your general health. So if you've got heart conditions and COPD and all this kind of stuff, this is elective surgery, we're going to say, no, maybe you're not a good candidate. Or if you are, maybe we're not going to do as involved a procedure, or maybe we're going to break it up a little bit and do this first and see how you do and whatever. But your health is probably going to be the biggest issue in how you recover. Kirstin (22:49): So we kind of talked about this a little bit, but if you are in your fifties and concerned with wrinkles and skin laxity, especially around the face in jowls, could you achieve some results with Botox and fillers? Or is it like no, facelift, you need a facelift? Dr. Koehler (23:11): Well, I mean, I'm not saying you can't use filler or Botox, it's just what's your end point? And typically when you start getting into that mid fifties to mid sixties, that's sort of prime time for these procedures. So I usually tell people, it's not like you can't do a facelift when you're 75. If you're healthy, you can do it, but I guarantee you that if you do a facelift at 55 and do another patient, their first facelift at 75, and you follow these patients, in a year's time or two time, the patient that's 55 is still looking really good, but the patient who had it at 75, even at a year, they're starting to see some relapse. Because it's like when you're young, kids change so quickly in these early years until they become adults. It's like every time you look at 'em like, well, they've changed so much in the past year. Dr. Koehler (24:05): Well, the same thing happens on the other side. When you start getting older at a certain age, we start accelerating and it's like, gosh, in a year's time, that person has aged a fair bit. And I hate to say that, but I mean, it's the cycle. So when you do it, when you're in your fifties and sixties, you have better skin elasticity, your general health is better, so the recovery is quicker, and on top of that, the result is going to last longer. So that's the typical question, people say, well, how long will my facelift last? I'm like, well, the cookie cutter answer we typically say is, well, in 10 years time, you should hopefully still be looking better than if you hadn't had it done. But again, this doesn't freeze you in time, even in two or three years time, you're going to see significant changes. It's not going to look exactly like it did. I mean, some people, I can honestly say I've seen some people three and five years later, and they haven't looked like they haven't changed at all. So that's great, but it's not freeze you in time. And again, the older that you tend to do it, the less longevity you're going to have with that procedure. Kirstin (25:11): All right. Is there anything else that men or women in their fifties should know? The most important gems? Dr. Koehler (25:19): The most important gems? Actually, you made me think of something, cuz I hear this sometimes on consults for people in their fifties, and they'll say this, I want to get a brow lift because I'm sick of getting Botox. And I'm like, yeah, but you know what? If you get a brow lift, you probably are still going to end up needing Botox. Now, maybe to a certain extent, you might not need as much because what happens with a brow lift, you're repositioning the brow, and if maybe you're constantly raising your brows because your brows are too low and you've got hooding of your eyelids, so yeah, you're straining and that kind of thing. Well, a brow lift might alleviate some of that straining, but the muscle's still there and the muscle's still working. And so you still, when you raise your eyebrows, will create wrinkles. A brow lift doesn't make that go away, so it's not a replacement for Botox. Kirstin (26:09): Okay, good to know Dr. Koehler (26:11): So another little pearl for you. Kirstin (26:15): All right. 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 (26:29): Thanks, Kirstin. Kirstin (26:30): Get back to making Alabama beautiful. Dr. Koehler (26:33): I'm trying. Announcer (26:34): 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'd like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, theaxis.io.