Baby Face

By Su Byron February 1, 2009

Remember that scene from Brazil where the plastic surgeon stretches the surgery-obsessed woman’s face like rubber until it looks like a hideous plastic mask? Old-school cosmetic surgery often had that effect, and maybe that’s why I am still ambivalent about the concept, even though I frequently report on plastic surgery as a health reporter for this magazine.


                I was reminded of that scene while sipping something new and trendy at a hip new downtown Sarasota café. I sat next to a table of four stylishly dressed women. Their faces all showed evidence of work—lots of it. When they laughed at the occasional joke, their taut, rigid faces didn’t move with their mouths. They seemed…paralyzed. The effect was creepy.

I leaned in for a better look. After all, I had just been charged with writing about what my editor described as the “new face” of plastic surgery.  Here were four perfect subjects. These women, with their sophisticated wardrobes and model-thin bodies, had clearly spent considerable time, money and trouble to present an attractive face to the world. They were of a certain age (late 50s, early 60s?) but it was hard to pin that age down. Any remnant of their original faces was long gone.

In fact, I pondered as I sipped my drink, their faces seemed erased. They looked more like Japanese Noh performers in whiteface than middle-aged women at home in their skin. The only feature that wasn’t thin was their huge, bee-stung lips—lips that would have looked sexy on a young Bridgett Bardot, but seemed clownish on these women. 

Were these examples of the new face of plastic surgery—or were they just cosmetic enhancements gone wrong?

I went to the experts to find out.

My first expert was Sandra Day, a clinical aesthetician and co-founder of NeoDerm Aesthetics. Day, an attractive woman in her early 60s, readily admits that she works hard maintaining her physical assets. After all, it’s her business. She had a facelift a few years back. Today, she keeps her face and upper body “rejuvenated” with various procedures, including Fraxel laser resurfacing (which she swears by), skin peels, microdermabrasion, Botox, dermal fillers (including Restylane and Juvederm), and advanced skincare products.

Day unabashedly faces up to the subject of aging.

“We don’t have to age like our parents,” she says. But that doesn’t mean we can stop the clock completely. “After a certain age, it’s time to age gracefully. Don’t try to look young forever—just look good as you can for as long as you can,” she advises. “And don’t obsess! The other day, my granddaughter asked me: ‘Is it hard to be pretty when you’re old?’ I had to laugh, because the answer is yes.”

I studied her face as she talked. It’s pretty and smooth—but not erased. I would have had a hard time guessing her age if she hadn’t told me. Her mannerisms and style tell you she’s not a kid. She exudes the graceful confidence that only comes with age. But her face? It looks fresh and youthful—without looking artificial or unnaturally young.

Day has a ready explanation for the four women I saw in the restaurant.

“It’s four bad facelifts—I can always tell. It’s the Joan Rivers or Priscilla Presley look,” she says. “When it’s done right, you can’t tell that someone’s had work. I’ve worked with surgeons for 35 years and have seen some dramatic advances. Now, instead of tightening the outer layer of skin, they modify the underlying structure for a result that’s less taut. And the advances in less invasive therapies like laser resurfacing, injectable fillers and high-end corrective skin products are also helping change how we age.”

Long story short?

“Do it sooner, not later. Don’t wait until you’re 60,” Day says. “Start using fillers and Botox in your 30s to prevent wrinkles. When my two daughters turned 30, I sent them products that stimulate collagen growth. It’s routine maintenance, like changing the oil in your car.”

Final words?

“Be realistic. If you’ve overexposed your skin to the sun, smoked all your life or just have plain bad genes—don’t expect miracles.”

I now had an idea of what the new face wasn’t: a Kabuki mask. It wasn’t about looking different or even younger. It was about looking more youthful. And there is a difference.

It was time to speak with a surgeon about the nitty-gritty details

I got an appointment with Dr. Scott J. Engel, the new whiz kid at Sarasota Plastic Surgery Center. He was eager to chat about his favorite topic—making people look more like they used to.

“The new face is fuller and fresher,” he said. “It’s definitely more Rubenesque, not the pulled look of 30 years ago. Today’s face has more distinct, chiseled contours—especially the jaw line—but also plumper, rounded cheeks. The overall effect is one of volume and softness.”

Engel is excited about fat. As we age, we lose subcutaneous muscle tone and tissue—and gain a sick, sunken appearance. Fat, he says, is living tissue. Under the right conditions, it can be transplanted from one location to another. He’s successfully implanted patients’ own fat into the mid-face region to achieve that baby fat volume. Study some of the latest celeb photos—Madonna, Liz Hurley, Demi Moore. They’ve all got these dewy, plump baby faces—with pinchable cheeks. Cheeks like that don’t exist naturally in the 40- and 50-year-old face.

Baby fat is where it’s at?

I peer closer at Engel’s face. Yep. He’s got pinchable plump cheeks that give him an impression of being even younger than his 34 years. In fact, I have to restrain myself from leaning over the conference table and giving him a motherly pinch. (I also find myself attempting to puff out my gaunt and sunken cheeks while we chat. After all, here I am—the perfect subject for Engel’s skills: ravaged by time yet untouched by a surgeon’s or aesthetician’s hands. Am I only imagining him studying me with a little too much scientific interest?)

“In the 70s, 80s and 90s, our techniques were based on lifting up the skin and pulling it back,” he continues. “We started to realize that deflation is also a major part of aging. Nowadays, we go much further beneath the surface. We actually go under the cheek pad and re-suspend the muscle higher. With fat implants, we can further create that illusion of youth.”

Engel agrees with Sandra Day about when to begin the process. Start sooner. “Our philosophy is to maintain your youthful appearance as you age. My wife is 32 and uses Botox regularly. When she’s 52, it will be easier to deal with,” he says.

His final words strike home: “Plastic surgery shouldn’t look plastic.”

When I leave the office, I’m reminded how Day described the new face. “In my estimation,” she said, “the face begins from the chest up. What’s the point of having a youthful-looking face if your neck and chest look your age?”

She was referring to the impressive advances in skin resurfacing and rejuvenation techniques, including her favorite method, Fraxel. Skin resurfacing is most commonly used to minimize fine lines, especially around the mouth and the eyes. But it can also be used on the hands and upper chest area to eradicate age spots, wrinkles and sun damage. Used correctly, that is. When it’s overused—especially on the face—the result is the mask effect. The skin has barely any surface left at all.

I wonder if that’s what happened to the Joker. Or a certain pop singer from the 1980s…

With that thought in mind, I head over to visit Dr. J. David Holcomb, a noted facial plastic surgeon. He’s one of a handful of doctors in the nation to participate in a study using a cutting-edge new facial rejuvenation technique called Portrait Plasma Skin Regeneration, a laser-free procedure employing nitrogen-based plasma that works below the skin's surface to stimulate remodeling of the skin's architecture. It replaces old and damaged collagen with significant amounts of new collagen, reducing wrinkles and tightening and improving skin tone and texture. The technique is slowly replacing some laser procedures because it has a reduced recovery time and actually stimulates collagen growth for up to a year.

I step into Holcomb’s suite of offices on a high floor overlooking downtown Sarasota. Just being here, I understand why people—mainly women—will risk emptying their bank accounts and undergoing surgery in their quest for youth and beauty. Here, all is tranquil and beautiful. The place looks more like a Ritz-Carlton suite than a medical office. I admire the discreetly placed flower arrangements, original art, tasteful furnishings and the chamber music wafting from hidden speakers. Beautiful women of indeterminate ages with soft voices offer sparkling water or hot tea.

I settle into a plush armchair with a thick copy of Vogue, eying Michelle Pfeiffer’s perfect 50-year-old face (she claims to be cosmetic surgery-free, but the hundreds of blogs dedicated to the subject protest her claims with passionate debates). Comfy and relaxed, I begin to question my bias against cosmetic surgery.

Who cares if I have to mortgage my house? People will stop asking why I look so tired all the time. Maybe I could persuade Dr. Holcomb to do my face today, right now. Just take me in the back room and get it over with. And maybe I could just stay here another week to heal. In this chair. Listening to this hypnotic music ...

Dr. Holcomb interrupts my reverie. After a tour of his surgery area and treatment rooms (more luxe furnishings and dramatic Sarasota panoramas), we sit down for an hour-long talk. The topic? His theory of the new face. He echoes the other experts.

“The days of the super-taut face are over,” he explains. “The mid-face lift has practically given way to fillers and laser resurfacing. But after a certain age, fillers alone are just window dressing. They don’t treat the underlying cause of the sagging skin and wrinkles. By age 50, as our skeleton shrinks, our skin becomes more elastic. There are three procedures, used in concert, that remedy this.”

He leans over the desk and unveils the magic trinity: “Lift to reduce sagging, fillers to add volume, and resurfacing to eliminate wrinkles and sun and age damage.”

Et voilà—the new face.

Holcomb often performs all three procedures in one session. Let’s say—just for the sake of argument, of course—that I were a test subject. He explains how he could “refresh” my face with a neck, mid-face and eye lift, erase my smile lines with filler injections, kill my forehead creases with Botox, and—as a finishing touch—use Portrait Plasma Skin Regeneration to artfully repair sun-damaged skin and tighten skin elasticity in my face and neck.

My defenses down, I’m ready to jump on the operating table. Then I hear the price tag: $32,000. Uh-oh. Unless I can convince my editor to put it on my expense account, I’m going to have to make do with my old face after all.

(Have I opened Pandora’s box? Will I ever be satisfied with this old face again?)

My last stop is Beatty Cohen, a psychologist, author and TV personage who recently turned 60. Dr. Holcomb gave her a facelift when she was 54, and she maintains her face with a variety of treatments. She looks great.

I tell her about my misgivings about this whole cosmetic enhancement thing. Why can’t we age gracefully? Isn’t it all just vanity? Concern with mere appearances?

She laughs.

“What’s wrong with vanity? What’s bad about trying to looking better? Nothing!” she exclaims. “Sure, some women go overboard. They’ll be shocked to discover an external makeover won’t solve all their problems—they need an internal makeover, too. If you don’t deal with internal issues—unresolved relationships, depression—a pretty face means nothing. Surgery is a quick fix for a bad self-image—but work on yourself shouldn’t stop there. You still need to seek out internal peace of mind.”

Wise words—but oh, baby, I’m beginning to realize that a plump, fresh new face could do wonders for my peace of mind. Just ask Michelle Pfeiffer—or if she’s still not talking, check out some of the dewy new faces with the dreamy smiles leaving plastic surgery offices all over town. Those grown-up women with the little-girl cheeks are proudly wearing the new Sarasota face—look closely the next time you’re at a chic hangout or gala event, and you’ll see for yourself. Just refrain from pinching.



How much will your new face cost? That depends on what procedures you need. Here’s a quick glance at local price ranges for some invasive and non-invasive treatments. The good news? There’s never been a better time to negotiate.

·        Rhytidectomy (Mid-cheek and neck lift): $6,000-$9,000

·        Brow lift: $2,000-$4,000

·        Blepharoplasty (Upper eyelid): $2,000-$3,000

·        Blepharoplasty (Lower eyelid): $2,000-$3,000

·        Filler Injections (Radiesse, Juvederm, Restylane): $400-$1,000 per treatment; several treatments are often recommended.

·        Botox: $350-$600

·        Portrait Plasma Skin Regeneration (Full face): $5,500

·        Fraxel Laser Resurfacing: starting at $100 per treatment for the area around the lips (several treatments usually recommended); more for other areas

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