23 June 2021 onur
Rejuvenation: A medical term used to refer to the restoration of youthful vigor and facial rejuvenation.
Prejuvenation: The general name assigned to preventive rejuvenation applications.
Let’s review some basics.
Facial aging does not progress at a constant rate throughout an individual’s life. It speeds up in some periods and slows down in others. Patients say, “I was fine, doc, but I just got older in 2 years”.
Facial aging occurs at different rates and in different forms, varying from one person to the other.
However, as a general rule, the period between the ages of 45-55 is the period when facial aging “accelerates”.
Until the late 90s, the average age for facial rejuvenation surgeries was 55.
People would age first, and after getting old, they would undergo surgery to return to their youth.
Neither patients nor doctors deemed it reasonable for someone who was not old enough to have surgery.
Medical circles would not welcome operating on a person whose face did not completely sag and whose signs of aging were not completely prevalent on the face.
10 years ago, when I had just finished my fellowship, I was rejecting – without much thought – a small number of patients in their early 40s who applied for facelift surgery.
I used to say that there would be no treatment without a disease.
At the Cleveland Clinic, we were operating on very old patients. In the same year, my friend, Dr. Esteban Marten, together with whom I was having my fellowship, conducted a study investigating the safety of facelift surgery in patients over 70 at the clinic and published his study in PRS.
Undergoing a facelift in early 40s was too “advanced” even in the most “advanced” clinic in the USA.
(Note: Cleveland Clinic is the clinic where the world’s first full face transplant was performed in 2009)
So what has changed?
How did this post come up?
As of today, the average age for facial rejuvenation surgery is approaching 45, both in my practice and in the leading clinics of the world’s leading metropolises.
People prefer to delay the appearance of aging signs with surgery (prejuvenation) instead of getting old first and then restore youth through surgery (rejuvenation).
The most important thing that made this paradigm shift possible was the development of surgical techniques (deep plane facelift, high SMAS facelift, endoscopic midface lift, etc.) with both more natural and more permanent results.
Another driver for the paradigm shift emerged when candidate patients developed a better understanding of the limits of minimally-invasive, non-surgical applications.
This is quite an interesting point because the concept of “prejuvenation” had actually emerged with minimally-invasive, non-surgical aesthetic applications (laser, fillers, PRP, mesotherapy, Botox, thread lift, etc.).
At the beginning of the 2000s, we thought that minimally invasive applications would delay aging as well as the age at which patients came for surgery. Similarly, we used to recommend these procedures to patients, saying, “It will rejuvenate you a little, but rather protect you.” However, the scientific literature in the last two decades did not support our thoughts. For instance, although hundreds of millions of doses of Botox have been injected worldwide in the last three decades, there was no scientific data showing that individuals who started to have Botox at the age of 30 aged later than those who did not.
When you replace the word “Botox” in the sentence above with other modalities, the result is still the same.
On the contrary, we observe that some applications deform the face and bring people to surgery earlier. Therefore, I explain anywhere, including this blog, that you should avoid treatments that apply energy under the skin/subcutaneously as well as high-dose and unconscious toxin applications and high-volume, repetitive fillers that cause the skin to stretch and sag.
One of the main reasons for the surgical prejuvenation trend was the public understanding of the cumulative cost of non-surgical practices. For instance, the cost of 8-12 milliliters of fillers, which you need to use to attain a change that will almost reciprocate the effect of facelift surgery, equals the cost of surgery in 2 years.
I tell my patients that I interview for prejuvenation that they will see the 30% benefit of this procedure right after the surgery, and the remaining 70% benefit within 10 years following the surgery. Indeed, in patients who undergo surgery in the early aging period, “dramatic” before-after differences do not come up as they do in patients who undergo surgery in the advanced age group. Most of the time, the people in one’s social circle do not realize at first glance that their friend was operated.
However, patients in the prejuvenation group can maintain a younger appearance not only in the age range of 45-55, but also almost throughout their lives, compared to individuals of their own age who have not undergone surgery. While your friends in the same age group are in the fastest phase of aging, you go through a relatively slower change.
Prejuvenation is an even more appropriate approach for individuals who are aged 35-45, are in the last 20% of their age category in terms of signs of aging and look older than they are. It is based on the principle that a person should have the best possible appearance during the middle-age period when the person is most active socially, emotionally, sexually and professionally and will live the most intensely.
In summary, we no longer tell patients to “get old and come back”.
Furthermore, for patients, facial rejuvenation surgeries have become a “career project” rather than a “retirement project”.
Finally, a warning:
Technique selection in prejuvenation surgery is even more important than in rejuvenation surgery. You cannot perform a prejuvenation surgery with any facelift surgery technique. Some techniques have a very short effect and little protective power.
Please feel free to contact us for detailed information about preventive approaches in facial rejuvenation and the prejuvenation concept.
Take good care…
… of yourself and your beauty.