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Age should not be a barrier to cosmetic treatments

Skin of elderly patients may be more prone to bruising after procedures

A combination of neuromodulators and fillers is suitable when providing cosmetic enhancement to the face in elderly patients, according to an assistant clinical professor of dermatology at the University of South Florida in Tampa.

“I like to use a combination approach,” said Dr. Susan Weinkle. “The fillers fill the etched lines and the use of the neuromodulator relaxes the muscles that have caused the etched lines.”

Dr. Weinkle spoke in San Francisco at he annual scientific sessions of the American Academy of Dermatology at a symposium on aging gracefully.

She regards elderly patients as those who are aged 70 years and older. One major consideration with such patients is pre-existing medication use, such as anti-coagulants. Patients may develop bruising with the use of fillers because of their anti-coagulant use, but that does not mean anti-coagulant therapy should be halted, Dr. Weinkle explained. She is a past president of the American Society for Dermatologic Surgery.

“Mature skin is often fragile, so these patients are more likely to bruise,” she said. “It’s not right, however, to discontinue anticoagulants [for fear of getting a bruise] because you are having fillers injected. A stroke is far more important to avoid than a bruise.

Restoring volume key in older patients Over time, there is a loss of volume in the face, which creates a sunken appearance, explained Dr. Weinkle.

Additionally, marionette lines develop around the mouth that suggest sadness. Returning volume to the face has a major impact on how elderly patients are seen by others, such that elderly individuals will avoid looking sad and tired, she said.

“Restoring the volume makes a significant impact on how the patient is perceived,” said Dr. Weinkle. “We make assumptions when we meet someone in mere seconds, assessing whether that person looks angry, tired, sad, or beautiful.”

There are several benefits of starting cosmetic procedures at an earlier age, said Dr. Kenneth Arndt, president of SkinCare Physicians in Chestnut Hill, Mass.

“Our philosophy is that if you start early, you can prevent the changes that arrive in later life that people are wishing to fix,” said Dr. Arndt, who spoke in an interview with “It’s hard to go back in time [and make changes].”

Factors that influence how early an individual should consider cosmetic procedures include the extent to which facial muscles are used daily, said Dr. Arndt, who is clinical professor of dermatology, emeritus at Harvard Medical School, adjunct professor of surgery (Dermatology) at Dartmouth Medical School in Hanover, N.H., and adjunct professor of dermatology at Brown Medical School in Providence, R.I.

“Animation can vary tremendously,” he said. “How people use their facial muscles in everyday discussion can be very different from one person to another. Some people are very animated, and if they are very expressive, then it would be reasonable to consider using neuromodulators earlier in their adult life.”

As a general rule, botulinum toxin works better in younger patients, said Dr. Arndt. “There can still can be a positive impact when you are 80 years old, but individuals will have more fixed lines and wrinkles [by that time],” he noted.

Contraindications to using neuromodulators include the presence of neurologic conditions such as Bell’s palsy, which affects the muscles on the face, noted Dr. Arndt.

Dr. Neil Sadick, clinical professor of dermatology at Weill Cornell Medical College in New York, and past president of the American Academy of Cosmetic Surgery, discussed

the future of non-invasive rejuvenation during the panel session on aging gracefully. A trend in the aesthetic space is that emerging fillers are producing decreased adverse events, said Dr. Sadick.

“There are many fewer side effects from the new generation of fillers.” An advantage of new generation skin tightening technologies is that they are less painful than previous generations of skin tightening technologies, he noted.

One of the latest technologies approved by the U.S. Food and Drug Administration is Kybella, a treatment that removes submental fat, noted Dr. Sadick.

New fat dissolving technologies Fat dissolving technologies such as LI PO- 202, an injectable formulation of salmeterol xinafoate, is being studied to treat central abdominal bulging due to subcutaneous fat in non-obese patients. The technology may become another tool in the toolbox alongside modalities like CoolSculpting, said Dr. Sadick.

Like other dermatologists involved in cosmetic medicine, Dr. Sadick focuses on collagen stimulation and restoration of volume for the face, among other interventions. “The goal is prophylaxis [of aging],” he said. “If you start skin tightening [procedures] earlier in life and collagen rejuvenation earlier in life, it's a wise thing to do.”

Originally published in the August 2015 issue of The Chronicle of Skin & Allergy

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