Anti-Aging in the Gables

A Fountain of Youth (for Every Age)

If you consult the Castle Connolly guide to the top doctors in America and check the section on Coral Gables, you will notice a preponderance of physicians in the business of beauty. Makes sense. Coral Gables is synonymous with elegance and good looks, and home to the kind of affluent residents who can afford such treatments. With that in mind, we consulted with local plastic surgeons, cosmetic dermatologists and cosmetic dentists to see what the latest treatments are to reverse the appearance of aging, with a focus on which procedures are right for each stage in life. 

Ah, Youth (20s & 30s)

What young patients most frequently request is an improvement of some unattractive feature that is genetic, says plastic surgeon Dr. Stephan Baker. “In your 20s, you are dealing with things that are improvable, that are inherited. The first thing is usually the nose,” he says. Improvement of the jaw line is another request, especially for those with a “weak” chin. 

Next, by your 30s, it’s time for Botox, says Baker. This is a new trend, based on the ability of Botox – or any other comparable neurotoxin – to stop wrinkles from occurring in the first place (versus trying to eliminate them subsequently). By reducing muscular contractions, “It prevents establishing wrinkle lines, such as crow’s feet [at the edge of your eyes] or marionette lines [between your mouth and your cheeks],” he says. 

“Years ago, we would not even consider anyone for Botox until 40 or 50,” says Dr. Carlos Wolf, a Gables facial plastic surgeon. “Now we have people coming in their 20s [for Botox], and it’s for a lot of things.” These include for getting rid of what are called “The Elevens,” those vertical forehead lines where the eyebrows meet. “They are looking at their selfies, and seeing Elevens,” says Wolf. “A lot of them are doing it to get rid of that scowling look.” 

Relaxing the forehead muscles also accomplishes a slight brow lift, says Dr. Wolf. “So many people think Botox is just about getting rid of wrinkles, but it’s really about upper facial rejuvenation. For young people it makes you look more inviting, more friendly. A slightly arched brow is aesthetically pleasing.” 

Melissa Fox, a skin care esthetician who owns and operates Flawless by Melissa Fox on Biltmore Way, says that patients in their 20s and 30s come to her for the rejuvenation of skin tones that have started to look less than rosy. “Patients in their 20s just want to glow, with pretty, dewy skin,” she says, which relies on “a good cleansing and good lifestyle choices.” Her spa performs “hydrafacials” for deep cleaning, especially of pores that have become clogged. “Everyone can have this done for an amazing glow,” she says. 

Next comes treatments for hyper pigmentation, or skin spots, which occur in your 30s from not using enough SPF. For this, Fox uses LED light therapy, in particular red light for hyper pigmentation and inflammation (rosacea). 

“Facial aging and facial rejuvenation is really a lifelong process,” notes Gables plastic surgeon Dr. Daniel Careaga, whose clinic is on Alhambra Circle. “It should begin in childhood by parents being diligent about making sure their kids wear sunblock. Ultraviolet radiation from the sun’s rays and cigarette smoking are the top two controllable causes of premature facial aging. 

Middle Age (40s & 50s)

When you get into your 40s and 50s, says Dr. Baker, it is time to start thinking of surgical procedures in addition to the good skin care habits developed in your 20s and 30s. “It really depends on the individual, whether you have been disciplined with exercise, nutrition and sun exposure,” says Baker. “You always start with the non-surgical procedures – laser resurfacing, Botox, fillers – but at some point, you don’t get enough return on your investment.”

“For middle-aged patients, from their 40s to their early 50s, we can start with more advanced procedures,” says south Gables plastic surgeon Dr. Johnny Soloman. “By that time, you really see some volume loss, skin sagging and skin changes. Depending on the degree that it is affected, you would consider [surgery for] forehead lifts, eyelid surgery, mini face lifts and lower face lifts. And also, some laser treatments to take care of the skin proper.” 

What is most typically treated with surgery at this stage in life are the eyes, especially the drooping upper eyelids, which start to look tired. “Excess skin inside of the eyelids can make a person look much older than their stated age,” says Dr. Careaga. “Blepharoplasty, also known as eyelid surgery, can have a profound effect on a patient’s perceived facial age.” The area beneath the eyes also starts to lose volume, says Dr. Oscar Hevia, a cosmetic dermatologist on Biltmore Way. “We use under-eye filler for the hollows under the eyes. It’s more genetic than age related, but by the late 40s and early 50s it is common in most patients.” 

Hevia also uses dermal fillers, which can last a year or two, to erase what are called “smile lines” that form on either side of the mouth. “The skin creases there and that leads to a crease or wrinkle … even when you are not smiling, so you start to get some fillers in there.” Patients in their 40s and 50s are also starting to see some neck sagging, which shows up as horizontal lines. “We can use filler to conceal or erase those lines, and Botox to get rid of some of the early sagging. Also, we can use threads,” he says, which pull the neck up underneath the skin. “They are not permanent, getting absorbed after a year and half or so, but they give a nice lift.” 

Other treatments for excess fat under the chin include “cool sculpting,” says Gables dermatologist Flor Mayoral, a process that breaks down fat and tightens skin using localized cold temperatures. She also uses radio frequency devices for patients in their 40s and 50s, which heats up collagen fibers beneath the skin surface. “Some of them get de-natured and are replaced by new collagen fibers. It’s a wonderful way to maintain a youthful appearance.” 

Skin damage from the sun in your 40s and 50s – including broken capillaries and color irregularities – can sometimes require the more forceful treatment provided by laser ablation, in which the skin is literally burned off so that it can grow back smooth and fresh. “It kind of breaks down by skin type,” says esthetician Margaret Haley, owner of My Derma Clinic. “We also have a host of different procedures used to address various concerns.” For those with less surface damage, for example, these include intense pulsed light for pigmentation and chemical peels. “A lot of people go to dermatologists for a blue light treatment,” says Haley. “That will take years off of the skin and kill pre-cancerous lesions.” 

Mature Beauty (60s & 70s)

When patients enter their 60s and 70s, treatments tend to be more aggressive and invasive, especially when it comes to sagging skin. “Loose skin can make you look prematurely old,” says Dr. Baker. “Cleaning up the neck and jowls really makes a difference, and fillers don’t cut it anymore.” 

For Dr. Careaga, the time for a facelift or neck lift comes with mature age. “In the 50s and 60s, as the skin of the face and neck begin to lose more and more volume, a facelift can dramatically restore the face to a more youthful look,” he says, so long as you restore volume at the same time. “On average, a well performed facelift can take a decade off of a patient’s perceived facial age.” 

The loss of facial volume, especially in the upper face, is a key sign of mature aging – and where dermatologists as well as plastic surgeons inject fillers. “The temples and cheeks are the best places to replace the fat that disappears,” says dermatologist Mayoral, who uses fillers with hyaluronic acid, a naturally occurring sugar in our skins that hold water and keep it plump. “It lasts two years, and you have to do it a few times if you are older. But little by little you start to look much better.” 

Other doctors, like Dr. Soloman, use patients’ own fat as the filler. While this is a longer procedure, involving liposuction and multiple tiny injections, the fat becomes part of your body for the long run. And both synthetic fillers and fat transfers become important at this age for the hands, as well. 

“Patients in their 50s, 60s and 70s especially start to worry about their hands,” says Mayoral. “The peculiarity of the hands is that there is a compartment that is separate from tendons, with veins and fat, and once the fat goes you can see the veins. We inject because the hands look boney.” Adds esthetician Haley, “Sometimes it’s not about the face. The neck, the hands, the chest can look so much older. And the hands have volume loss, but you can address that with fillers.” 

When it comes to the face, however, fillers may not be enough at this age, say plastic surgeons. “There is a loss of volume as you age, but if you keep injecting [patients] with fillers, without anything else, it looks like apples in their cheeks.” What has to happen is some sort of face lift as well. “The balance has to be between fillers, Botox and surgery,” says Baker. 

Ultimately, there are no hard and fast rules about when a particular operation needs to be done, says Dr. Careaga, “Because not all collagen is created equal. Our DNA codes, our exact breakdown of collagen, is one thing we cannot control … The important things are to eat a healthy diet, exercise regularly, avoid cigarette smoking, always use sunblock, and follow the recommendations of your dermatologist, plastic surgeon and esthetician.” 

And Then There Are the Teeth… 

A critical part of looking younger and more attractive is our teeth. Procedures by cosmetic dentists don’t really break down easily into age groups, however. It is more of a continuum, says Dr. Laura Davila, DDS one of the partners at Coral Gables Dentistry. “The biggest thing is maintenance,” says Dr. Davila, by flossing, brushing and coming in for cleanings. “When you are younger you go [to the dentist] twice a year, but as you age you see more wear and tear” – and your mouth tends to be drier, with less saliva to balance the pH after what she calls “an acid attack” from things like coffee or candy. Her recommendation: Older people should see their dentists every three to four months, at least for a cleaning. They should also arm themselves with top brushing technology, using water picks and rotary toothbrushes. Even with the best of care, however, teeth deteriorate. “They are more calcified, less translucent, and darker as you age, with less enamel, and can’t be easily whitened,” says Dr. Cristina Osorio, DDS, Davila’s partner. For that, there is the latest in “onlays,” aka capped teeth. “We do that more with older adults.” The main thing, she says, is to be able to smile.