The Age of Agelessness : Plastic Surgery Symposium in Newport Draws Throng

Gravity, sun and time have conspired against you, and now you don’t like looking in the mirror as much as you once did. Instead, you spend more and more time perusing the plastic surgery ads, wondering if there’s a doctor-magician out there somewhere who can make you look like the women--or men--in the pictures.

But before you resort to such drastic measures, how about a free, instant, and completely reversible face lift, courtesy of the doctors at the Scripps Clinic and Research Foundation in La Jolla?

It’s quick, easy and quite painless.

Ready?

Step 1: Pick up a mirror.

Step 2: Lie down on your back.

Step 3: Look up into the mirror.

The face you see there is a “pretty good preview” of what you’d look like after a face lift, according to Dr. Ross Rudolph, who heads the division of plastic and reconstructive surgery at Scripps. Bags and wrinkles are minimized but not erased. If you hoped to see the face of a 19-year-old fashion model looking back, you’re not alone. Most prospective plastic surgery patients have the same unrealistic expectations, Rudolph said at a recent Scripps symposium on “Rejuvenating Aging Skin” at the Four Seasons Hotel in Newport Beach.

“Then you get the patient who comes into a physician’s office and asks for a ‘mini-face lift,’ ” says Dr. Stephen H. Miller, a plastic surgeon at Scripps who chairs the American Board of Plastic Surgery. “Then she says she has an important social engagement coming up in four days, and she has a minimal amount of money, so she wants to put it on her MasterCard but she’s $100 away from her limit.” As the crowd chuckled, Miller filled in the caricature. “And she doesn’t want her husband to find out, so she asks you to make sure he can’t see the scars.”

The presentation was the first Scripps has made in Orange County, and organizers were overwhelmed at the response. Nearly 600 people--mostly women--attended the two-hour session, and more than 600 others who couldn’t get in signed up for a future session.

As the baby-boom generation grows older, the effects of aging--and what can be done to slow or reverse them--have become a hot topic, Rudolph said.

As skin ages, it becomes thinner, drier and less elastic, he said. Although fat may collect in other parts of the body, it diminishes in the face, and that contributes to wrinkling and sagging. Sun exposure also causes surface wrinkles.

Surgery can minimize some of those problems, and others can be helped with chemical peels, dermabrasion or collagen injections. But so far, nobody has figured out a way to turn back time, the Scripps doctors said.

The first, and possibly the most important, step for a plastic surgery patient is choosing a doctor. And that can be confusing, Miller said. “A few years ago, I would tell people to make sure their doctors were board certified,” he said. But that’s not enough now, because many of the people who are not approved by recognized medical societies have formed their own boards.

“Many of the surgeries being performed are by individuals without the credentials necessary to be board certified,” Miller said. He advises checking with local hospitals and colleagues before choosing a physician. “You have but one body to give,” he said. “Be careful to whom you entrust it.”

It’s important to discard those unrealistic expectations early on, Miller said.

A common misconception about face lifts, he said, is that once you’ve had one, you’ll need another, and another. “Do you have to have it again? No. Does it last forever? No,” he said. “Some people, if they are heavy with very loose skin, may need the operation again within eight to 12 months.”

Face lifts have improved from the old tightly pulled, artificial look to a more natural appearance, the doctors said. A new technique involves tightening underlying muscles as well, which improves the effect. Price vary greatly, but at Scripps, the typical face lift costs $4,600 to $6,200, the doctors said.

Rudolph, Miller and dermatologist Hubert T. Greenway of the division of Dermatology and Cutaneous Surgery, showed several before-and-after slides of their patients, many of which drew “oohs” and “ahs” from the audience. “These women are wearing makeup on the post-operative photo,” Rudolph explained. “This was not intended to deceive you, but it’s part of the process. We send patients to a cosmetician afterward to learn how to use makeup, and these pictures were shot when they came in for their post-operative visits. I’ll be darned if I’ll ask somebody to take off their makeup just for that. But I want to make sure you know the improvement is not just from the surgery.”

One advantage of aging skin, Rudolph said, is that, “as you get older, scars heal easier and less visibly on the face. Unfortunately, that’s not true for the trunk, and if you have surgery there, a breast augmentation or abdominoplasty--a tummy tuck--you will have a more visible scar. But no scar ever becomes invisible.”

The advent of liposuction, in which fatty tissue is literally vacuumed out of the body, has given plastic surgeons another tool for sculpting faces and bodies. In addition to areas of the body with large accumulations of fat, doctors also use liposuction to remove bags from under the eyes and tighten the neck.

But surgery isn’t always the answer, said Greenway, who explained such dermatological techniques as collagen injections, chemical peels and dermabrasion. Collagen, he said, flattens deep furrows temporarily, but is eventually absorbed by the body. Some doctors in Mexico have used liquid silicone for the same purpose, “but you have to be careful with that. We had one patient who got silicone injections in Mexico and they migrated into her cheeks. She looked like a chipmunk.”

Chemical peels--in which acid solutions are applied to the face, peeling off the skin’s outer layer, and dermabrasion--which involves literally sanding the skin, are sometimes the best answer to fine wrinkles, Greenway said. But there are side effects. “Two weeks later you look like you’ve been mugged by a Brillo pad,” he said. Both techniques work best on light-colored skin.

Retin-A, the anti-wrinkle drug approved in 1988, may not be as effective as first thought, Greenway said. “It was initially tested on the forearm, and it seems to work better there than on the face. The changes are very subtle.” He also advises against going to Tijuana to buy Retin-A over the counter. “What you buy there may or may not be Retin-A,” he said.

Although the audience was mostly women, the doctors said more men have begun to embrace plastic surgery.

“It’s no longer dismissed as surgery for vanity’s sake,” Miller said. “It’s becoming culturally and emotionally acceptable, because you are a whole person, and what you look like does have an effect on how you feel about yourself. To dismiss that as vanity seems awfully shortsighted.”