Every woman wants to know the secret to staying beautiful, no matter what age. There’s so much information on anti-ageing methods that sometimes it can be overwhelming, and it’s hard to know what is best. RESCU sat down with renowned plastic surgeon Dr Stephen Mulholland who was in Sydney for Cynasure Symposium. Here’s his advice on the best preventative methods to combat ageing at every stage of life, so you can stay fabulous forever.
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RESCU: Welcome to Australia, again! We’d love to talk to you about anti-ageing in some specific areas. As you know Australia is an ageing environment, so there’s a lot of awareness and interest in pre-surgical options.
What would you say are some of the pre-surgical options you recommend for the hard to treat areas such as the neck and the jaw.
Dr Mulholland: Yes, I am a plastic surgeon but 60% of my income comes from non-surgical services. I had a practice for 10 years in LA so like Sydney I’m very used to sun damage in young people.
It always starts with basics: sun protection, sun protection, sun protection! Inevitability you’re going to get some sun damage as no sun protection is UVA/UVB not UBC and Infra-Red and that discolours and damages skin.
So, we often never forget to put stuff on our face but we forget our neck and the back of our hands, so off face rejuvenation is very big, and you can divide that into surgical and non-surgical.
In the surgical world it’s colour correction. This can be Topical Cosmeceuticals or Bleaching Agents. Particularly in environments like Sydney where you have light skin individuals with dark discolouration, or Asian patients or Hispanic patients with discoloration so bleaching regimes that are non hydroquinones and then good old intense false light photofacial, after 20 years is still a great way to colour correct.
Now we’ve got to improve texture, texture happens with energy based devices, especially on the neck; things like radio frequency devices such as Pelleve, Venus Freeze and Exilis or any of the devices out there that create new collagen and elastin. Fractional technologies can be bundled with those other two at the same time.
RESCU: So that’s for firming and texture?
Dr Mulholland: Yes, so IPL for colour, Radio Frequency for tightening and firming and then for that iguana skin, those fine lines and wrinkles that does great with Fractional Technology. So, there are the fractional lasers like Erbium and CO2 and they’ve been around for a while. For darker skinned patients you have to worry about hypopigmentation because there is a fair amount of thermal exchange with the skin.
The Bulk Heating Radio Frequency Fractional Devices and the Needle Based Devices that have silicon coating are wonderful for the neck. There are a number of devices like that in Australia, the EU, Canada and The United States.
Generally off face, neck, we start with combination energy based devices, IPL, Bulk Heating Radio Frequency for tightening. You can notice some amazing changes!
Then there’s injectables, so Topical Injectables like PRP, Stem Cell Therapy and Fractional Needling with topical serums that will allow more penetration. Then under the skin heating, where you’re not really cutting anything but your putting lipo fibres under the skin directly.
RESCU: Wow! So that’s a firming technology?
Dr Mulholland: Correct.
RESCU: Does it simulate collagen production as well?
Dr Mulholland: Much more profoundly because you don’t need to worry about the skin surface and burning the skin surface, because you are right under the skin.
RESCU: So how is it delivered?
Dr Mulholland: It’s delivered with long probes or laser fibres externally, through the skin.
RESCU: Like Smart Lipo?
Dr Mulholland: Yeah similar to Smart Lipo but even smaller fibres now, you take a little needle, make a poke in the skin and put the fibre under the skin with no stitching or cutting involved and that sub dermal heating is a great way to treat the neck, particularly with women between 40-60 not ready for a neck lift.
RESCU: Is there a device name because I’ve never heard of it?
Dr Mulholland: Yes so the common ones would be InModeRF, ThermiRF and PrecisionTX, those are the big 3.
Also, Suspension Techniques are still out there, and seem to be gaining more momentum.
RESCU: Is that the S-Lift?
Dr Mulholland: Yeah, so they’ve been around for a while and are gaining more momentum and popularity because the construct now is bio absorbable so you can put these in and get tightening, and the whole product goes away so your not having these threads hanging around your neck for months and months and months or years and years and years.
RESCU: When is the time to start treating that area? It seems to be that area that creeps up on you one day.
Dr Mulholland: It really does! Young women when to start? Right away! sun protection in your 20s. In your early 30s usually your looking at collagen stimulation (Bulk Heating RF , Colour Correct IPL and the Fractionals) and then, if you’ve got a bit of a double chin in your late 20s-30s you can add KyBella.
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RESCU: That’s the new Allergan one right?
Dr Mulholland: Yeah, and it’s been a great product. It’s a simple way to dissolve fat. So you look after contour and shape, you look after texture. Most women will start in there 30’s because that’s when you start to see it. We peak as humans in youthfulness at 28. From 28, sadly it’s all downhill! You add a couple of marriages and babies
RESCU: You just said the story of my life, two ex- husbands one child and I live in Australia!
Dr Mulholland: Which means lots of sun! So you may be starting 10 years earlier than people in Nordic countries that may only travel to the Mediterranean twice a year. You guys have sun all year round so you’ve got to be careful. So I would start in the 30s and 40s for those things. Once you get into your 50s under the skin heating devices in addition to that, and eventually there’s a lot of really cool mini neck lift procedures.
RESCU: Talk to us about that
Dr Mulholland: Mini neck lifts are done behind the ear, you gather up the skin, do some heating techniques under the skin like InMode RF, ThermiRF or PrecisionTX and then you pull this skin and hide it behind the ear. It takes about an hour and a half, no stigma of surgery because it’s hidden behind your ear.
So the days of doing the big neck and face lift once you get to 65 are gone. Usually its eye in your 40s, mini neck in your 50s and maybe a cheek in your 60s so its top floor middle floor bottom renovations rather than tearing the whole house down when it’s really dilapidated, which used to be the way we did things in the 70s, 80s and 90s.
RESCU: It’s interesting you say that because I was going to ask you, do you think that it would make a face look strangely compartmentalized in ageing? But you’re saying no because different parts age differently?
Dr Mulholland: They do. It’s around the eyes that show the first signs of age, so you can do a little laser skin pinch and do a lift, maybe a brow lifting and fillers and then the cheek and neck start to fall , but cheek is usually the last to fall significantly. So the problem in the past actually is a premature cheek lift that has made it look worse, if you do everything when it isn’t necessary it can look weird. So it’s usually every decade your dealing with a little tweak and you can constantly look 15 years younger. Fillers doesn’t serve you very well when you’re older, and Botox doesn’t serve you very well when you’re younger. If you do little things at the right time, it can look like you never age
RESCU: Never age! I love it. Thank you that was so insightful.