Everlasting Cosmetic Appearance

Reviewed by and Scott R. Miller, MD, FACS

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Cosmetic plastic surgery procedures are designed to improve the appearance of your bodily or facial features. Unfortunately, they do not last. Non-invasive, minimally invasive, and major plastic surgery procedures do not stop the aging process. Whether it's three months or ten years, eventually you will need follow-up and maintenance treatments, or additional surgery. This article will help you understand how ongoing procedures and a treatment plan can help you achieve a more everlasting appearance.

Even after plastic surgery, the treated area will continue to age. There are many possible reasons for the changing appearance, so it's difficult to estimate the longevity of a plastic surgery procedure or other cosmetic treatment. The most successful outcomes typically result from a combination of procedures, with a detailed plan for future treatments.

The Elements of Skin

People have three primary skin layers:

  • epidermis layer (surface layer)
  • dermis layer (below the surface)
  • hypodermis or subcutaneous tissue layer (below the dermis layer)

The epidermis layer houses skin cells, chains of amino acids, and pigment. The very top layer of the epidermis consists of keratinized or dead skin cells. Skin treatment exfoliates this layer to make the skin look better. The dermis layer also contains skin cells, along with oil and sweat glands, blood vessels, nerves, and hair follicles.

The dermis and hypodermis layers contain many of the same elements, except that the hypodermis layer also includes fat. Each layer contains connective tissue that is supported by collagen fibers, which provide condition and support to the skin. Collagen production naturally decreases with age, which decreases skin elasticity, which causes thinning and sagging of the skin.

How Aging Affects Treated Areas

Thinning, sagging skin may impact the appearance of a plastic surgery procedure. For example, implanted devices such as breast implants may be more visible through the skin over time. In the case of a facelift, the positive appearance may alter if an untreated area sags more than the treated area. This is also true for patients who undergo blepharoplasty, but do not let the eyelid surgery recovery period take its natural course or those who do not understand the eyelid surgery risks. While the treated area may look better, it too will continue to age. All areas of our skin are subject to the same effects of thinning dermis and loss of fat in the subcutaneous layer as we age.

Volume and Bone Loss

A recent study by the American Society of Plastic Surgeons found that facial bones lose density, causing the bone structure to remodel or shift with age. At the same time, age-related collagen loss reduces the skin's ability to tighten around the remodeled area.

Certain untreated facial features may affect your overall facial appearance. For example, the nose may become larger with age. In the years after a facelift, the nose may be disproportionate, contrasting against the treated facial features. Volume and bone loss may occur in other areas of the body as well as the face, contributing to an overall appearance of aging. So even while the plastic surgery results may remain intact for a positive long term impact, other features may change and produce and undesirable contrast. And of course, treated areas of the body and face continue to age.

Facial Movement and Wrinkles

People move their faces an estimated 15 hours per day throughout their lifetime. Squinting, smiling, laughing, chewing, grimacing, and expressions of surprise may all affect the ultimate appearance of our faces. Repeated facial movement may also affect long-term appearance after a facial procedure. These repeated movements over the years may ingrain fine lines around the mouth and eyes, eventually forming troublesome wrinkles.

Ongoing Treatment Plan

While it's true that appearance will change over time after cosmetic plastic surgery procedures, there are options available to treat changes as they arise.

Non-invasive and minimally invasive procedures require ongoing maintenance with periodic treatments. For example, Botox lasts for three to six months. Restylane may last for six months or more. And Thermage may last for up to two years.

In a 2003 Stanford University study of patients who had laser skin resurfacing treatment to improve the appearance of fine lines, acne scars, or sun damaged skin, results indicated that 46 percent of the initially satisfied patients were not fully satisfied after 30 months. These treatments do not improve severe wrinkling. Once a patient graduates to severe wrinkling, a facelift may be more appropriate. The treatment plan in this case may also include injectables and fillers to lend volume to surrounding areas that are not treatable with a facelift.

Most plastic surgery procedures do not last a lifetime. The gold standard facelift procedure may last ten or more years. Neck-lifts may provide an improved appearance for five or more years. Eyelid surgery results may be visible for ten years. "Mini" and "micro" procedures may last only five years. Procedures that require implantable devices such as breast implants may also require a repeat procedure. For example, the FDA found that there was up to a 30 percent re-operation rate among breast implant patients. Many of these cases were due to the aged appearance of the breast or the desire to increase breast size.

Plan for the possibility that aging can undermine your appearance in and around areas that have been treated. You may need a secondary procedure in the treated area to combat the ongoing effects of aging, or additional procedures in surrounding areas to achieve balance. Periodic treatments, secondary surgery, and combination procedures are all part of the comprehensive treatment plan that you develop in consultation with your doctor.

Special Considerations

A qualified doctor will help you select the most appropriate treatments for your condition, increase the odds of success, and reduce the risk of complications. Here are some tips to keep in mind:

  • Doctor's Qualifications: Be sure to check your doctor's qualifications and the number of times the doctor has performed the procedures you are contemplating.
  • Appearance Over Time: Ask the doctor if the procedure will affect body or facial movement and expression over time.
  • Medical Records: Collect and store medical records from plastic surgery procedures in a safe place. Store specific information about any implantable devices that you have. For example, a breast augmentation patient may require re-operation for one implant, but not the other. It's very important for the doctor to know the type and size of the implant in order to provide symmetry between the breasts and avoid an unnecessary procedure.
  • Expenses: Investigate your insurance provider to see if they will pay for a secondary procedure if required. Since many insurance companies do not pay for secondary procedures regardless of the reason, it is important to plan for the additional expense.

Moving Forward

Medical associations such as the American Society of Plastic Surgeons have developed initiatives to reduce re-operation rates. Advances have been made in techniques to provide longer-lasting results. Improvements have also been made in technology and implantable devices to enhance results. The wisest approach is to research plastic surgery procedures and cosmetic treatments, develop a treatment strategy with a board-certified plastic surgeon, and have realistic expectations.