“I’m sure my friends think that I’m the last person to have a facelift, since I never wear makeup and I like wearing shorts and sneakers. I’ve always been sort of a tomboy,” says Maryland resident Susan*, age 60. But a facelift is just what she did. It started when Susan, a trained nurse, was asked by two friends to help them when they had their facelifts. “It got me thinking and doing some research.”

Susan chose Maryland plastic surgeon Dr. Michele Shermak. While talking about a facelift, Susan told Shermak that she had also always been bothered by her 36DD breasts. She ended up scheduling a breast reduction and a lift. And while doing that, she added in an upper eyelift, with more surgery to come.

According to Shermak, clients like Susan represent today’s consumers. “There has definitely been a trend to combine procedures,” says Shermak. “No one wants to undergo surgery and take off from work and other daily activities twice.”

A smiling Susan says, “Having a breast reduction was the best thing I ever did. It made me feel like a new person. I’m now about a medium-C and can wear shirts I never could before, and my buttons aren’t popping open.”

THE PRIZE ON THE EYES
As people age, their eyelids stretch and the muscles supporting them weaken. As a result, the eyelids begin to droop and get crepey. Maryland board-certified plastic surgeon Gregory Dick says, “Upon meeting someone, the first thing we look at are their eyes and we can quickly gauge the person’s mood, health, vitality, and age.”

Susan remembers, “I was beginning to think that I was looking older than my age, which was not something I wanted.” Susan had what is called blepharoplasty, an eyelid lift achieved by removing all of the extra skin that might have accumulated on the eye as a result of aging, gravity, and loss of elasticity. Blepharoplasty gives the patient a refreshed appearance without telegraphing to the world that they’ve had plastic surgery. Patients heal well and scars are very forgiving—often totally imperceptible. It’s not a very painful recovery and results last a long time. Dick says, “That’s why the eyes are the big bang for the buck, the best use of one’s funds.” Susan would certainly agree. She says, “It made me [look] brighter and took years off my face.”

THE FACELIFT COMES OUT OF THE CLOSET
“Today, there’s more information online about plastic surgery. I think when fashion designer Marc Jacobs at 58 had a facelift in 2021 and documented the entire procedure, it gave a lot of people something to think about,” says Shermak. The average age of her patients getting procedures done is 50-plus. The most popular age range is anywhere between 50 and 70, though she says she’s seeing younger people coming in for work, in part thanks to Zoom. “They want to look refreshed and there are many ways to achieve this from a mini-facelift or a neck lift, to a lower facelift, full facelift, to injectables.”

Several months after her first procedures, Susan underwent a lower facelift with Shermak. A lower facelift focuses on everything below the corners of the mouth and includes nasolabial folds (creases extending from both sides of the nose to the corners of the mouth), marionette lines, jawline, the submental (under chin) area, jowls, and the neck. Susan’s surgery was performed in an accredited surgical center, and she went home the same day.

“I went to a work meeting with people I hadn’t seen in a long time and one person was staring at me,” Susan happily remembers. “When I asked what was wrong, they said, ‘I can’t put my finger on it, but you look younger.’ I think it took 10 years off my face. It’s so natural looking, not like the tight Joan Rivers look of years ago.” Susan finished her journey with a lower eyelift in 2022.

THE MOMMY MAKEOVER
Maryland resident Amy says, “I’ve always had a weight problem.” So, after losing 40 pounds and knowing she was finished having children, Amy had a consultation with Maryland plastic surgeon Dr. Michael Cohen about having work done on her breasts and abdomen. This procedure has become known as a “Mommy Makeover.” According to Cohen, “Mommy Makeovers are very popular and it’s mostly for women in their 30s, 40s, and 50s who have had their children. They’ve seen changes in their mid-section as well as possibly in their breasts, even though they lead a healthy lifestyle, exercise, and eat well.”

“Some things just can’t be corrected without surgery,” he continues.

Many women show Cohen pictures of what they think is attractive, which is helpful as it gives a good idea of what they want.

“A “Mommy Makeover” can involve a tummy tuck—removing fat, skin, and tightening muscles—liposuctions and, for the breasts, just a lift or having an implant to restore firmness,” says Cohen. “Other times it’s a breast reduction, and sometimes a woman wants to go bigger.”

Amy, who had two C-sections, had a “Mommy Makeover” in June 2021. The seven-hour surgery involved a tummy tuck, breast reduction and lift, and liposuction on her back and hip area. Cohen says, “Generally recovery is anywhere between three to six weeks.” For her part, Amy is thrilled with the results. “My clothes fit so much better now,” she says. “There are no bulges.”

NO SURGERY, THANK YOU
Not everyone who wants to turn back the clock or look refreshed wants surgery. “Today, there are many non-invasive procedures to address a multitude of issues,” says Maryland dermatologist Dr. Robert Weiss, of Maryland Dermatology Laser Skin & Vein and an investigator on many procedures. “And now many products and procedures that were delayed because of the pandemic are becoming available.”

Maryland resident Linda, who is in her 60s, was having her yearly skin checkup when her dermatologist, Dr. Margaret Weiss—whose husband is Dr. Robert Weiss—asked if there was anything she wanted to address. “I was like, ‘I really hate the dark circles and puffiness under my eyes,’” says Linda, who has never wanted injectables.

Margaret Weiss, also at Maryland Dermatology Laser Skin & Vein, told her about a new non-invasive device, Tixel, that could correct that problem. After showing her the literature, Linda went home, thought about it, and made an appointment. “They gave me numbing cream before the procedure, so it wasn’t painful,” says Linda who had four treatments, each about 15 minutes. “I was a little red, but there wasn’t any downtime. And after the treatments, I had people commenting on how beautiful my eyes looked,” says a pleased Linda.

Be On Trend

Curious to know what’s trending?

According to the American Society of Plastic Surgeons, these are the top five surgical procedures of 2020, the year for which there is most recent data:

◼ Nose Reshaping
◼ Eyelid Surgery
◼ Facelift
◼ Liposuction
◼ Breast Augmentation
◼ Other high volume surgical procedures, including tummy tuck and breast lift

AND THE TOP FIVE MINIMALLY INVASIVE COSMETIC PROCEDURES:
◼ Botulinum Toxin Type A (Botox, Dysport, Xeomin)
◼ Soft Tissue Fillers
◼ Chemical Peel
◼ Laser Skin Resurfacing
◼ Intense Pulsed Light (ILP Treatment)
◼ Other high volume minimally invasive procedures:
Noninvasive Fat Reduction,
Nonsurgical Skin Tightening

GAME CHANGERS
Robert Weiss explains that, “Tixel has been available in Europe for about four years and in the States in the last year. It works with thermal energy that is delivered through a titanium treatment head. It’s safe to use around the eyes and during the treatment we use a Zimmer cooler that blows cold air on the skin. Patients report it’s about a zero-to-one on a scale of zero-to-10 for pain. It tightens the skin, improves tone and texture, and lifts eyes for sagging eyelids or eyebags.”

In other words, Tixel is something of a non-surgical eye lift. “My European colleagues say that it can last several years,” he says. “We are also using it to get rid of the lines around the mouth. There is no downtime, and it gets better over time.”

For those who want immediate results on upper lip lines, there’s Redensity, a new category of fillers classified as a dermal booster. It’s superficially injected to boost the dermas. Unlike many other fillers, there are no bumps or lumps, so the final result is a natural look.

Weiss says that he prefers Tixel because it lasts longer compared to Redensity, which, like other fillers, only lasts about a year. Tixel can last up to five years.

Another injectable, DAXXIFY (DAXI), a competitor of the ever-popular Botox, has been getting a lot of hype. Weiss explains that while it was delayed by the pandemic, DAXI is an injectable treatment that promises to be longer-lasting than others on the market, and rather than having three treatments a year, only requires two.

“Patients who are happy with Botox might not change,” he says. “But patients who would rather come into the office only twice a year may find it appealing. Of course, a lot will depend on pricing.”

“Whatever injectable we use, we never want our patients to have that deer-in-the-headlights look,” he concludes.

There’s still more that’s new on the market. The latest of the Restylane family of hyaluronic-acid injectables is Restylane Contour. Used in the cheek area, it volumizes as well as lifts in a very natural subtle way, and lasts about a year.

THE SHAPE OF THINGS TO COME
As everyone knows, it’s easy to gain some weight, and even when we don’t, our weight tends to redistribute, especially as we age. Dr. Shirley Olsen of Maryland says, “One patient came in when she couldn’t zip up her jeans. The funny thing was she hadn’t gained any weight, it had just shifted. And by wearing only leggings, she didn’t know. The good news is that CoolSculpting did the trick. All her jeans now fit.”

Olsen, who has performed over 10,000 CoolSculpting procedures, is now using CoolSculpting Elite. It is used for the treatment of visible fat bulges in the submental (under the chin) and submandibular (under the jawline) areas, thigh, abdomen, and flank. It can also combat bra fat, back fat, underneath the buttocks (also known as banana roll), and upper arm.

“CoolSculpting Elite results in 18 percent more fat reduction than the older Legacy,” says Olsen. “There’s less bruising, it is more comfortable, and can do up to four sites at once. In 35 minutes, the total treatment is done.” The manufacturers of CoolSculpting also say there is some skin tightening. But it’s important to know that it’s not a treatment for weight loss.

Another non-invasive treatment is EMSCULPT. It’s the first esthetic device to build muscle and sculpt your body. Through high-intensity electromagnetic therapy, one can firm and tone muscles. This procedure builds muscles and burns fat without having to hit the gym and do sit-ups to get that six-pack. For best results, four treatments are recommended over the course of four weeks.

“Today the goal with all non-invasive treatments is a better but natural look,” says Robert Weiss. And with so many women—and men, too—exploring ways to ward off aging, there are certain to be more and more injectables and procedures coming to market.

*Some of the names in this story have been changed to protect the privacy of the subjects.

CoolSculpting has been a buzzword in magazines, blogs, and radio ads for the past couple of years now. But what exactly is this supposedly magic fat-freezing procedure, and is it safe? We talk to plastic surgeon Dr. Carrie Houssock about what CoolSculpting is, its benefits, and its long-term results.

What is CoolSculpting?
CoolSculpting is a non-surgical option for fat loss. Typically, people get it on their stomach and flanks, but they can also have it done on their inner and outer thigh as well as their upper arms. The procedure uses a cooling mechanism to freeze and eliminate stubborn fat. There is no down time needed for this treatment and little to no discomfort.

Are there any risks or side effects?
Yes, but the amount of risks and side effects are low. One of the side effects you could experience is pain or discomfort during or after the procedure. There could also be some swelling in that area for the first 24 hours or so. In other cases, the area where you had CoolSculpting done can be numb for a few months after the treatment, but it will eventually subside.

What is the actual process like?
First, you come into the office and we weigh you and take some photos of you pre-procedure. We then fit the head of the CoolSculpting machine to whatever part of the body you are having worked on. There is a gel pad that we place between you and the machine, and then once we press start it begins to suck your skin, tissue, and fat into the machine. At first it feels a little funny when you feel the suctioning, but it is generally not painful. The procedure lasts about an hour, and our customers usually use that time to watch TV or use their phones. Then we turn the machine off and pull the machine off. Your skin will be hard and cold, almost like an ice block, at this point. So we then do a massage to break down the tissue.

When do you see results?
It takes about three months to see results and to notice a difference. It is not like a surgery would be, where you would see immediate results. I suggest people wait until the three-month mark for a follow-up appointment where we will weigh you and take photos again.

Is this a safe procedure for everyone?
The ideal patient is someone who does not want the down time of an operation, who has a small amount of stubborn fat but is overall fit, and who does not have a lot of excess skin. CoolSculpting will not treat excess skin and significant amounts of adipose [fat storing] tissue. It will never give you the surgical result, but it is a good option for those who do not want to have a surgical procedure.