Is 50 Really the New 30?: How Modern Aesthetic Medicine Has Given Us A Decade of Delay in Facial Aging

Phrases like “50 is the new 30” are popular these days but is there basis in fact?  Dr. Bass discusses how lifestyle changes in the past few decades and the ascendance of non-surgical techniques in plastic surgery–often termed aesthetic medicine –have transformed how we look at a given age.  These changes have also transformed our expectations of how long we will be able to stay looking young.  Botox, injectable fillers like Restylane and Juvederm, energy based devices like lasers and advances in skin care (cosmeceutical and pharmaceutical skin products) comprise the bulk of what’s been happening in aesthetic medicine.  Dr. Bass discusses the role of each, what age is a good time to start and what a combined program of care can produce.



Doreen Wu (00:00):
Welcome to another episode of Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I’m your co-host Doreen Wu and I’m excited to be here with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The title of today’s episode is, “Is 50. Really the New 30? How Modern Aesthetic Medicine Has Given Us a Decade of Delay in Facial Aging.” Today’s episode. Title is really interesting. It’s especially relevant because phrases like 50 is the new 30 and 40 is the new 20 are becoming more and more commonplace. So, Dr. Bass, what does the title of the episode mean?

Dr. Lawrence Bass (00:42):
Well, it’s really about how our appearance or what people typically look like at a given age has really completely transformed since we were younger. Life is better. We’re traveling through life, better, healthier, we’re living longer. And as a consequence of that better health, we look better and it’s not just our health, but it’s also the things we’re doing to preserve and maintain our appearance. So how, how we look at 50? What, what the mental image of that is for most people is what somebody who was in their thirties used to look like in our parents’ generation. We, it’s also a change in what our expectations are. And if you go younger and younger and younger, you see that change in expectation, millennials and people younger than millennials are already planning that they’re going to do things to not accelerate their aging appearance. They’re going to do things to prevent and preserve their appearance in ways the past generations just didn’t get involved in partly they didn’t get involved because life was different. There was less affluent, partly because a lot of the technologies and treatments didn’t exist. But it’s a complete transformation in what we’re doing at a given age and how we’re expected to look.

Doreen Wu (02:19):
Exactly. I think as the world’s population is getting older and we’re living longer, more and more people are looking for ways to combat the signs of aging and maintain their useful appearance by kind of having this beauty maintenance routine and establishing that early on. Why has this shift occurred? What has really changed?

Dr. Lawrence Bass (02:40):
Well, it’s really the ascendance of nonsurgical options. The ability to make really substantial changes in appearance without doing aesthetic surgery. And I’m a plastic surgeon. I like aesthetic surgery. It’s my industry. And I think it can really do tremendous things for people, but it’s not the right maneuver for many stages of aging, particularly early stages of aging. And we really didn’t have a good option for people early in the game, people in their twenties, people in their thirties, we needed those options. And there has been huge output from American industry and around the world to create meaningful non-surgical treatments that help us. And so that’s not just protection, but prevention and maintenance, along with restoration,

Doreen Wu (03:41):
Let’s start with lifestyle changes. First people in this generation are living drastically different lives than say their parents and their grandparents. What are some of the ways our lifestyle has evolved?

Dr. Lawrence Bass (03:53):
The two biggest factors in skin aging are sun and smoking. So obviously there are some big changes in lifestyle compared to our parents and grandparents, many fewer people smoke. And we clearly recognize the impact of sun on skin aging, wrinkling, all kinds of skin changes, pigment changes, and also skin cancer, of course. So we don’t always stay out of the sun, but at least we’re aware of it. And we have sunscreen that we can use to help protect. There’s also much better fitness and much better understanding of the importance of participating in fitness activities compared to previous generations. And our diet has improved. We eat less fat, less salt, less carbs, and we understand the impact. These things have on health and not just health, but also appearance.

Doreen Wu (04:53):
It’s good to know that we’re taking steps in the right direction. We’re adopting healthier habits and living healthier lifestyles. What has happened in plastic surgery and aesthetic medicine?

Dr. Lawrence Bass (05:03):
So there are several categories of things that have really made a big impact. And again, are in that category of nonsurgical options. One is the durable or modern fillers that started to come on the market about 2003 and 2004. Another is Botox and other neuromodulators Jeuveau, Dysport, Xeomin, that helps smooth out wrinkles and keep us from ironing in these wrinkle changes over decades. There are energy devices that are used to tighten the skin to support skin health, to clear out pigmentary lesions and redness and their skincare.

Doreen Wu (05:53):
Okay. Let’s take them one at a time, starting with Botox.

Dr. Lawrence Bass (05:57):
So, as I said, the idea is not to iron in changes. There there’s a lot of lines on the face that are dynamic in nature that are promoted by muscular tension, even resting tension. And certainly by the muscular pressure that we experience when we smile or talk or animate,

Doreen Wu (06:20):
Naturally people wonder when is the right time to start getting Botox?

Dr. Lawrence Bass (06:25):
So opinions differ about when it’s a good idea, there’s this notion of, of prevention or what some people call prejuvenation versus waiting until you need to maintain the skin. But as the skin ages, we wrinkle more because our skin is not as elastic. So if a 20 year old smiles and they make a big enough smile, they’ll crinkle up the corner of their eyes. But if they make an average smile, they won’t because their skin is pretty firm and springy. If you’re 40, if you make even an average smile, you’ll wrinkle up. Typically some of the corner of your eyes, because your skin is less elastic than it was when you were 20. So our need for looking our best with Botox goes up as we age, but the benefit of not starting to iron in lines when we’re young is something that we still think is worthwhile.

Doreen Wu (07:28):
Where do fillers fit into this picture?

Dr. Lawrence Bass (07:31):
Well, fillers are about volume restoration and volume changes in the face. And the beginning of shape change in the face is one of the earliest changes we see in aging. So the fillers support shape, they help minimize the appearance of early laxity. And every time we inject fillers, we get some neogenesis. We get some rebuilding of the collagen in the skin. And because filler injections are repetitive treatments over time. These things make the skin much better than it. Otherwise would’ve been, had you been doing no treatment at all?

Doreen Wu (08:11):
Now let’s talk a little bit more about skincare. What are the big things happening in that realm?

Dr. Lawrence Bass (08:17):
Skincare is, is a huge category. And there are literally thousands of skin products out there and other kinds of skin treatments, not products per se, that are being done. So it’s really, really big. But the basic idea is that some skin products on the face and some attempts to care for your skin beyond just washing your face is an important thing to be doing.

Doreen Wu (08:49):
There’s a huge buzz right now around clean skin care, retinols, vitamin A, all of that type of stuff. What are the main categories of materials?

Dr. Lawrence Bass (08:58):
There are several categories that many of the medicated skin products fall into. So the basic idea here is that a good skin product. That’s a sort of a cosmetic product or an over the counter product you might get at the store. They’ll typically improve the appearance of the skin and they’ll protect the skin. You know, the skin needs an Alion protective layer. We don’t want the skin to be stripped raw because it’s, it’s exposed that way. So a little bit of protection from a good skin product is a good thing, but the doctor’s office products, prescription products will typically have medications in, in them that modify the biology of the skin in some way that is favorable or helps restore youthful behavior in the skin. So the big categories are things like Elafin, beta hydroxy acids. These are things like glycolic acid, lactic acid, pyruvic acid, that’s one big category of products.

Dr. Lawrence Bass (10:04):
And those are very affordable products. Typically they exfoliate and they stimulate some skin turnover at a higher rate, which again is more like youthful skin. There are retinoids. These are vitamin A analogs. These do the same kind of things they’re exfoliating, but they significantly stimulate new collagen and help improve organization of collagen. And maybe even some impact on elastin. Another category nowadays are products that have significant amounts of growth factors of one sort or another growth factors that stimulate blood supply in the skin, or that stimulate collagen production. They’re all manner of products, but these are things that try to stimulate the skin to turn on things that are slowing down or working less efficiently as the skin ages. There are other products that have botanicals that have similar kinds of bioactivity. Uh, and there’s a huge host of products with variable levels of impact to chase pigment, to chase skin quality and texture. Uh, but overall, an important start even when we’re young are things that are protective so that the skin is adequately moisturized and has that protective Amalian layer. And finally, the, the other big thing is sunscreen. I mean, sunscreen is critically important. We’re always getting exposed to ultraviolet indoors and outdoors and some level of protection from that, which is, again, one of those two big preventable factors in skin. Aging is critical. If you want to maintain your appearance,

Doreen Wu (12:03):
Lastly, we have energy based devices. What do they do? And how do I pick the right one?

Dr. Lawrence Bass (12:09):
So again, this is another huge subject onto itself where there are literally hundreds of devices out there using variations on several different strategies for the skin. So there are things like laser resurfacing, which is kind of the gold standard for creating a lot of rejuvenation in the skin, addressing wrinkles, pigment, texture, many, many things in the skin, but that’s something that’s most appropriate during the restoration phase. If you’re in that stage of aging, there are a whole spectrum of devices that are more focused on prevention and earlier restoration. So there are many sizes to fit all needs, whether you need a little improvement or more moderate improvement, you really can’t say, okay, here’s the device that’s right. Or the best or great, because they’re all trade offs in terms of how many treatments you need, how much improvement you’re likely to get, how good a fitted is for your type of skin and your stage of aging.

Dr. Lawrence Bass (13:25):
The important thing to remember is it’s always going to be about steps, maintenance and prevention is a process. It’s not an event, so it’s not gonna be something you do once. This is an American sentiment. We want to do one treatment, look drastically better, or be protected forever. And it just doesn’t work that way. And it, and it’s very much like dental cleaning. You could have the best cleaning from your hygienist, but if you’re not brushing your teeth at home, your teeth are going to be in trouble fast. Likewise, you could be brushing your teeth really well at home, but if the hygienist doesn’t occasionally come in and clean off any buildup that you’re not able to get at home, you’re eventually going to get in trouble.

Doreen Wu (14:12):
That makes sense. I know we all wish there was this magic wand that we could wave and somehow magically turn into our 20 year old self. But for now that doesn’t exist. So overall Dr. Bass, what should we remember to stay looking our best and make 50, the new 30?

Dr. Lawrence Bass (14:29):
So like every other aspect of our health care and maintenance has to start when we’re young. And that makes a huge difference. You know, you can’t wait till you’re sick to start taking care of your health. You need to be doing sensible things when you’re young. So start early. Do as much as you comfortably can do. Most of us don’t want to play with our skin three hours a day, but even some skin care is better than none. When you accumulate that over decades, you’re gonna be in a much better place if you’ve been doing something than if you just let it go, do something that’s meaningful for where you are in the aging process. So, you know, if you’re in your twenties, very simple things may be meaningful, a little bit of a medicated moisturized product, uh, and a little bit of sun avoidance or sunscreen use. But as you get older, you have to pick other options to really be having an impact on anti-aging, you know, on prevention and maintenance. So this starts with, with skincare in small ways, but increasingly it becomes medical. It needs to be managed in partnership with a professional. Eventually you get to a stage of aging where surgical treatments are going to be needed to look your best. But these occur later in age and much later than they used to with good skin health and prevention activities.

Doreen Wu (15:59):
Thank you for sharing your insights with us. Dr. Bass, I learned a lot about how modern aesthetic medicine has provided us with a huge repertoire of tools and techniques to delay aging. If you think of other exciting developments in plastic surgery that you would like us to discuss in upcoming episodes, please reach out. We’ll see you next time. This is Doreen Wu, thanking you for joining Dr. Bass and me for this discussion of different aesthetic treatments designed to delay the effects of facial aging. Be sure to join us next time. And don’t forget to subscribe to our podcast, to stay up to date with all of the exciting content that is coming soon.

Speaker 3 (16:35):
Thank you for joining us in this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor patient relationship is established by listening to or participating in this podcast, consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.

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