Dr. Bryce Cowan says that patients should first consider what changes that they are undergoing, so that they can understand what the surgeon is proposing to address these problems better.

Next, the patient should research the surgeon to ensure that they have the education and experience necessary. Patients should ensure that they have a good relationship and communication with the surgeon as well. Good communication and clarity goes a long way to ensuring a more satisfactory outcome. The patient should feel comfortable with their surgeon.

At the same time, skill and experience is important. The unfortunate reality is that everything will not go exceptionally well all the time. It’s important that surgeons perform when things are smooth, but it’s also important that surgeons are also able to handle the procedure well when things aren’t ideal, and complications occur. There’s a protocol for how to deal with complications and patients and surgeons should discuss these scenarios as well.

Patients should also feel comfortable seeking a second opinion or alternative, and surgeons should not feel offended by this. It’s important for patients to educate themselves more about their concerns as well as possible solutions so patients should feel empowered to learn more. Patients should be wary if a surgeon seems to be wanting to give a hard sell. Cosmetic surgery is patient focused. It’s extremely important that you be educated and comfortable with the procedure. The right time is when you want to go through with it, not when someone else wants you to.

Being cosmetic or elective procedures, these costs are privately paid by the patient. First, there are many factors affecting the cost of the treatment such as the country, state/province, the performing surgeon and their experience or reputation, facility, and of course the type and scope of the procedure or procedures. In general terms, however, Botox and fillers are in the range of hundreds of dollars. These treatments are quite reasonable and are affordable for people even in their 20s and have a wonderful effect on their appearance. At some stage, as the patient ages more and is starting to see other more significant facial changes, they will start requiring multiple syringes of filler for the same effect. As fillers and Botox are temporary, only lasting for 6-9 months, the costs can start to balloon at this point. At this point, a patient may start to consider a more fundamental and lasting correction with cosmetic surgery. This can end up being more cost saving over time as the changes are lasting, and it can address some problems that simply revolumizing with fillers simply cannot change. For younger patients, however, I think Botox and fillers will often serve their maintenance needs better in most cases.

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Patient Research: How Would Patients Choose Their Surgeon?

The first groups of patients that cosmetic surgeon Dr. Bryce Cowan advises against surgery is smokers. Smoking elevates the risks of complications as tissue healing is affected, and there are higher rates of infection, and higher rates of tissue death or necrosis can be expected. Given that the patient is already paying significant sums for a cosmetic procedure,they should want to ensure that all goes well, and it’s not ideal to do it when the risks of complications are this high. However, those patients could become great candidates for cosmetic procedure once they’ve stopped smoking for a significant period of time.

Patients need to be able to both understand and accept the risks of surgery. It’s a balance between their motivation and desire to undergo surgery and their willingness to accept the risks involved with that procedure. Surgery does come with risks, and patients need to weight these out against their desires. Finally, patients should truly desire to undergo surgery of their own accord. Sometimes there are external reasons like their job or their loved ones that drive some people to undergo surgery. In many of these cases, we advise that the patient rethink their decisions and motivations.

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The Cost of Treating Aging Face

The ideal candidate depends on the specific treatment, but in general terms, we are looking at a patient who is a healthy, non-smoker, does not have high blood pressure, does not require anti-coagulants, is in their late 40s or early 50s, where the impact of the surgery is highest.

This person would have a clear appreciation and understanding of what they desire from the procedure, and at the time both understands and accepts the risks that come with the surgical procedure.

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Unfit Candidates for Cosmetic Surgery

Plastic surgeon Dr. Bryce Cowan explains that the main advantage is that cosmetic surgery allows for a more profound and long lasting correction that’s not possible with other treatment options. Treatments are rarely one treatment versus another. Cosmetic surgery is often used in conjunction with treatments like Botox and fillers for maximum effectiveness, as corrections are often multi-faceted.

Another very important point is that the appropriate timing for cosmetic surgery can be critical. Some time between the early 40s to the early 50s is when the face begins to change in profound ways. As changes in the positions of the facial structure and the shape consequently changes, it’s at that point that cosmetic surgery can uniquely provide lasting and impressive change. Many cosmetic surgeons say that there is a “sweet spot” in time, between a person’s early 40s to early 50s that cosmetic surgery has the most profound effect.

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Who Would be the Ideal Candidate for Cosmetic Surgery to treat Aging Face

Patients should assess their age, the changes associated with aging that are taking place, and their willingness to undergo the procedure, and the willingness to take on the risks and potential complications associated with the procedures.

Botox and cosmetic fillers have a good safety profile when used by a trained injector. The cost of these treatments are far lower compared to cosmetic surgery. These treatments typically require ongoing maintenance. Soft treatments are often more popular with a younger age group as the facial changes are typically more minor, and for these types of needs, Botox and dermal fillers are invaluable.

With age, these treatments often become insufficient, although they still provide some value in maintenance. A more profound correction is often needed in the older person to maintain the appearance of youth. It’s at this point when structural changes begin to occur that cosmetic should be considered.

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Advantages of Cosmetic Surgery when Treating Aging Face

What cosmetic procedures might be useful for a given patient? The two key principles of aging of the face are volume loss and tissue malposition. There are many elements changing simultaneously, so it’s very rare that there is an effective singular procedure that can act as a fix all solution.

Early on, perhaps in a patient’s late 20s or 30s cosmetic fillers, Botox and other soft procedures can make great improvements, but at a certain stage, when there is significant change in the shape of the face, only a cosmetic surgery can restore the normal position of the facial structural elements like the fat pads and the tissues before adding back the volume with a filler or Botox. It’s the combination of repositioning through cosmetic surgery, and restoring lost volume through fillers or Botox that optimize the final outcome.

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Botox, Injectable Filler, and Cosmetic Surgery to Treat Aging Face

Dr. Bryce Cowan gives us the truth about aging, cosmetic surgery, and the difference between non-invasive procedures like Botox/fillers vs cosmetic surgery. First, there is no way to truly stop aging–it’s a continuous process. Plastic surgery is looking to delay or camouflage that process. There is no true reversal of aging as the process is continuous, and eventually those signs of aging will become evident.

In a patient’s 20s or 30s non-invasive treatments like Botox or dermal fillers may be a great option. Botox can really help reduce the presence of wrinkles in this age group and prevent fixed wrinkles from forming by freezing the muscles in that area. Similarly fillers are also very useful for fixing fine lines that may have already developed. Other soft modalities like laser and chemical peels can also have a dramatic improvement on the quality of skin.

At some point, however, the only way to truly stabilize and even “reverse” the symptoms of aging – even though again I want to be careful with the use of that word – is with cosmetic surgery once a patient gets to a certain age. Once the patient starts to show significant changes in the face, like the overall loss of the inverted triangle of youth, the only way to change that in a meaningful way is to reposition the facial elements to their proper place with cosmetic surgery, prior to adding back volume.

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Debunking Common Misconceptions about Aging Process

Plastic surgeon Dr. Bryce Cowan takes us through a tour of expectations in terms of the physiological changes that occur. Understanding that there are individual differences, it’s a guide of what we can expect in our coming years. The aging process begins a lot earlier than most of us understand it to be.

By the mid to late 20s, we’re starting to see dynamic wrinkles around or between the eyebrows from movements or facial animation. For some people early stage fixed wrinkling may be starting. These wrinkles typically become more established in the 30s. These dynamic and early stage fixed wrinkles are the predominant signs of aging in this age group.

In the mid 40s to early 50s, we start to see major changes in the attenuation of the face, and the “inverted triangle of youth” begins to break down. The fat pads which initially sit high in the face in youth, begin to dissolve and the supporting ligaments that hold the fat pads in these positions break down, which causes hollowing of the cheeks, and the overall youthful look to fade. The combination of general loss of volume and the change in relative position of the fat pads continues causing heaviness of the nasal folds, jowls, and other known features of aging to appear.

In the 60s, these processes compound, thinning of the skin becomes more apparent, and elastin proteins deteriorate further, and wrinkling also occur in other areas as well. Relaxation of the underlying muscles also cause neck bands and other folds as well. Finally, these changes are different for every individual, based on their genetic and environmental backgrounds and one patient may not see these changes occur for a decade later than another patient.

See our subsequent videos for treatment options, the pros and cons in considering the various modalities.

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Treatment Options for Facial Aging

The upper, mid, and lower face all age as we go through the decades. Plastic surgeon Dr. Bryce Cowan explains how symptoms of aging typically manifest over time. In our youth, our face is full of expression. These are called dynamic wrinkles – they form and express our various emotions–they come and go as we change expressions. With age, these wrinkles slowly become more deeply formed, and fixed. As we lose elastin the key protein that gives the skin the ability to stretch. When this happens in the areas like our forehead, the brows begin to drop. The supporting ligaments also lose strength, causing the deep sunken appearance around the eye area, sometimes causing the eyes to have a bulging look. These can cause the expression to change, making the face appear more angry, and even interfering with the ability to see well, called lateral hooding. As the facial muscles are overused to try to make up for this, this eventually leads to the formation of more wrinkles in the upper face.

Fat atrophy and loss of volume are another key factor in facial aging. In combination with malposition of key fat structures, these are the key principles of aging. It’s the fat pads that give our face shape, and they are supported well when young. Malposition occurs as these fat pads, typically higher in the face begin to drop lower as its support structures weaken. The midcheek fat pad or the buccal fat pad tends to drop vertically, eventually resulting in a common feature in people in their 50s, as jowls. The youthful face is demarcated by the shape of an inverted triangle. With age, the support is lost and the fat drops to the lower face. At the same time, thinning of the skin, and resulting crepe-like look also becomes a problem.

See our subsequent videos for treatment options, the pros and cons in considering the various modalities.

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Face Aging: Decade by Decade