By William Byron Barber II, M.D.

Q.  I would like to do something to my face to make me look younger. I am 60 years old, recently retired and feel great but I see wrinkles and jowls on my cheeks, and loose skin under my chin. What are my options regarding facial rejuvenation, and is there anything other than surgery to tighten my face and reduce my wrinkles?

A.  Sorry, but the short answer to your question is that only surgery will lift the loose skin on your cheeks and under your chin. Wrinkles (fine lines) can be treated with laser skin resurfacing, which technically is not surgery since there are no incisions, however, laser is still a procedure with a week or so recovery and can have a short period of being uncomfortable. Fine lines or wrinkles on the face do not respond very well to face lift surgery and are better treated with laser. Often, a combination is done where a face and neck lift are first performed to take care of the loose skin, and then 6-12 months later laser resurfacing is performed to further smooth the skin wrinkles. Unfortunately, there is no non-surgical technique that will tighten loose skin. You should make an appointment with a board certified plastic surgeon so that you can be evaluated as to what may be available to achieve a more youthful face for you. 

Q.  I recently saw my primary care doctor who did a yearly physical including examining my breasts. He noticed that my breasts were kind of hard and a bit misshapen and he asked me how old my breast implants were. I told him they were more than 30 years old and he looked surprised. He suggested that I see a plastic surgeon to find out about how safe it is to have such old implants. I have had a mammogram every year since I turned 40 and have never been told there is any issue with my implants. Do you agree that I should be evaluated for my implants? I am 63 and had my augmentation in my early 30’s.  

A.  Let me ask you a question. Are you happy with the look and feel of your breasts? Normal breasts, with or without implants, should be relatively soft and should have a normal breast shape. If you have hard misshapen breasts, then you likely have a capsular contracture, which is scar tissue that has formed around your implants. Over time this scar tissue will compress the implant and make it feel hard, like there is a baseball in your breasts instead of a soft implant. To answer your question, I absolutely agree that you should see a plastic surgeon who regularly performs breast augmentation and breast implant removal to discuss what is going on and what your options are for treating your likely contracture. One of the more common reasons for a contracture in old implants is leaking silicone gel. If your implants are leaking, then I would recommend removing the implants along with the surrounding scar tissue (capsule). You will have the choice to either not replace them or replace with new implants. Go see a board certified plastic surgeon, you will feel better about your situation once you know exactly what is going on.