Ten years ago, Dr. Habib Khoury's patients were typically women in their mid-60s whose faces clearly showed the ravages of time and gravity. The full face-lifts he performed restored the firmer, unlined visages of their younger years. But the dramatic results, revealed to the world after weeks of recuperation behind closed doors, came with a consequence: the gossipy whispers that they most certainly "had something done."
Today, the Westlake cosmetic surgeon and his peers are performing a multitude of less drastic options to soften or eliminate the signs of aging. And patients, both male and female, are scheduling them as soon as the first lines and sags appear. According to 2010 statistics provided by the American Society for Aesthetic Plastic Surgery, people ages 35 to 50 scheduled 44 percent of all cosmetic procedures performed in 2010; another 20 percent were scheduled by 19- to 34-year-olds. As a result, even close friends and relatives are left to wonder just exactly why they look so much better. Khoury says the benefits of these less invasive interventions extend beyond the more subtle yet significant improvements. For example, some procedures are performed under a local anesthetic; others require no pain control at all.
"We've basically been able to eliminate the risk factor of using [general] anesthesia," he says. "The patients are completely comfortable, they get great results, and it's very affordable."
The most popular nonsurgical procedure, according to both local doctors and ASAPS, is the injectable botulinum toxin (better known by trade names such as Botox and Dysport). Khoury explains that a shot into a facial furrow — typically frown lines, crows feet, even vertical lines around the lips — blocks nerve signals that make the underlying muscle contract, "deactivating" the muscle for four to five months and in turn smoothing the line caused by its movement.
Second on that list of nonsurgical fixes is another injectable: a synthetic version of hyaluronic acid, a gel-like substance found in the body's connective tissue that is used to fill wrinkles and folds.
"It acts like a sponge," says Khoury of the product, marketed under names such as Juvederm, Restylane and Perlane. "It binds with molecules of water, so it creates a localized swelling."
The most common sites to be treated with this dermal filler are the folds extending from the corners of the nose to the corners of the mouth. But doctors also use it to plump cheeks and lips as well as fill hollows under the eyes and deep furrows that can't be erased by botulinum toxin injections alone.
Like the effects of botulinum toxin, the results achieved with hyaluronic acid are temporary: The body absorbs it within 12 to 18 months. But Khoury prefers it to longer-lasting fillers such as Radiesse, which he describes as a calcified material used to build areas of prominence such as cheekbones. "I've never seen an allergic reaction to hyaluronic acid," he adds. "So in my opinion, it's completely safe."
More lasting effects can be achieved with outpatient surgical procedures that require a minimum of time on the table and recovery at home. Both Khoury and Dr. Vasu Pandrangi, a cosmetic surgeon with offices in Westlake, Middleburg Heights and Parma, mention the blepharoplasty, or eyelid lift, as a prime example. The procedure ranks third on ASAPS's list of the most popular cosmetic surgeries for 2010.
The upper-eyelid lift removes loose skin and slack muscle through an incision made in the upper-eyelid crease while the lower-eyelid counterpart excises unsightly bags of fat through a cut in the conjunctiva, or mucous membrane lining the lid. (If the patient has under-eye skin and muscle that needs to be tightened, Khoury says the incision is made just under the lower lash line.)
Those looking to obliterate signs of aging in the lower face schedule a mini face-lift, a less invasive version of what ASAPS says was 2010's seventh most performed procedure. According to Westlake cosmetic surgeon Dr. Edward A. Levy, "mini" refers to the reduced number of areas addressed and repositioning of tissues under the skin rather than the length and placement of incisions, which are hidden in creases above, in front of and under the ears. Typically, it focuses exclusively on the jaw line and neck. Another pared-down surgery, the mid-face-lift, raises the upper cheeks through incisions behind the hairline.
"There's less swelling, less bruising," Levy says. "Most people are comfortable being back to work within about 10 days."
Pandrangi notes that less aggressive surgical options are not limited to the blepharoplasty or mini face-lift. For example, he can remove a little fat under the chin and tighten the neck muscle through a small incision placed in the crease under the chin. Other surgeries are more personalized. He tells of a woman who chose surgery to remove folds of excess skin from the top of her nose. While he was at it, he disabled the muscles that cause the lines between the eyebrows and on her forehead through the same incision.
"Surgeries are really tailored to the patient's needs and desires," Levy concurs. "We look at the financial aspect, how much downtime they have to get healed and back to work."