- What some cosmetic surgeons don't realize is that lower face aging is also the result of hyperactive muscle movement.
Ironically, holds one practitioner, some of the very cosmetic procedures intended to stem Time's tide may actually age the skin further. Not surprisingly, the degree of skin aging resulting from cosmetic surgery is proportional to the invasiveness of the procedure, according to Frank Michael Prager, M.D., a private general practitioner in London, who has trained in the U.S. and Canada.
Dr. Prager tells Cosmetic Surgery Times that his concern is not with visible scarring, but rather, with the tissue damage that may accompany invasive procedures. The aging effect often takes years, post surgery, he holds, but "Procedures like extensive liposuction go hand-in-hand with large soft and connective tissue damage, which results in scarring, which results in lymphatic and circulatory deficiencies. All this accelerates skin aging and connective tissue damage due to tissue atrophy in the long run. Generally, after extensive lipo, the patients might look good with their clothes on, but will rarely feel comfortable wearing a bikini." Dr. Prager, a member of the British Association of Cosmetic Doctors since 2003, trained with Drs. Alistair and Jean Carruthers in the cosmetic use of Botox, and with Dow Stough, M.D., in Hot Springs, Ark. in follicular hair transplant surgery.
Dr. Prager feels that similar skin aging results from facial cosmetic surgery, contending that severing healthy tissue and blood vessels and detaching the dermis from the underlying muscle inevitably creates scar tissue and reduces effective circulation.
"Smaller blood vessels will soon grow, but they will not be as effective as the larger vessels that used to supply the skin with the blood and nutrients it needs," he explains. "The coagulation that is done during the operation to prevent post-operative hematoma significantly reduces the blood supply to the dermis. This is extremely aging since the neovascularization and revascularization during the healing process does not normally achieve the same levels of perfusion as prior to the operation." As a result, he holds, skin that is operated on becomes thinner.
"Plastic surgery has failed to understand the aging process and the underlying causes for facial aging as a whole," Dr. Prager states. "Now we know it's volume that makes a face look younger —not tightness. If we blame gravity for facial aging, which traditionally applies forces in a vertical manner, why does a facelift pull and stretch horizontally, meaning from front to back, often leaving the hairline behind the ears? Faces can be stretched, but the effects don't last, so you have to keep stretching. Surgery ultimately creates a flat, hollow face without the smooth, round, softness of youth." If, in fact, it's the lack of volume that makes a face look old, he continues, then the traditional facelift makes the face look even older, as the face is thinned at the cheeks, which were fuller, rounder and softer prior to the surgery.