Taking Care of Your Skin at Any Age
I had the pleasure to sit down with Dr. Bryan Forley, a Manhattan based Plastic & Reconstructive Surgeon. Dr. Forley is one of the few plastic surgeons who tells his patients what will and won’t work for them. He doesn’t look at a patient from a financial perspective but truly as a model who wants to be perfected by an artist. His passion comes through as he speaks about his work and being a perfectionist. All his clients are word of mouth and that is truly what he prides himself on. I’m grateful Dr. Forley found time to share his insight on the latest and greatest treatments available.
SL: The winter elements can be harsh on the face. What do you see as the biggest complaint from some of your patients?
Dr. Forley: Winter and the start of a new year is often a time of reckoning when the desire for self-improvement reaches its apogee. It is a time when people want to address the aging changes they see in themselves that have been simmering all year long or prepare for the inevitable warm weather seasonal shift to outdoor activities when their bodies will be more exposed. A broad array of concerns frequently gets addressed at this time of year giving me the opportunity to perform a great variety of surgical and non-surgical procedures.
SL: I know both men and women worry about sun damage and wrinkles especially to their face. What do you recommend to your patients that is non-invasive?
Dr. Forley: The most non-invasive recommendation I have for sun damage and wrinkles is prevention! Premature aging from excessive sun exposure is a pervasive problem that can be prevented or at least minimized with common sense measures such as regular use of sunscreen on not only the face but the neck, décolletage, hands, and body. Regular use of moisturizers will help to keep the skin hydrated and thereby less susceptible to the development of damaging free radicals that are caused by UV exposure and environmental pollutants.
SL: We are a big fan of Evoke and know that you are one of the few plastic surgeons to use this treatment. Can you share with us how it works?
Dr. Forley: Surgery is not for everyone so Evoke gives us an alternative treatment that is completely non-invasive and can produce meaningful results in selected patients. The technology involves delivering radiofrequency (RF) energy below the skin to improve the contour of the jawline and the neck without any downtime or pain. The RF energy is delivered from electrodes held in place for each 45-minute session by a specialized treatment mask for each area and results in a bulk heating effect. Following a series of 3-6 treatment sessions, a visible improvement can be seen that is very natural in appearance and complements other non-surgical aesthetic procedures. The duration of the result will vary but maintenance treatments are generally done at 12-18 months.
SL: Let’s talk about cellulite as I know that is a problem area for many people. What treatments do you offer for those patients?
Dr. Forley: Cellulite is a pervasive problem that is seen mostly in women after a certain age. It is related to fat distribution, fibrous bands that traverse the fat to the skin surface, and hormones. Multiple treatments are available from creams to energy devices to injectables all of which have mixed results. Often when many solutions exist, it is a sign that none of them work that well. We recently began utilizing the Morpheus8 Body device to tighten skin, remodel fat, and disrupt the fibrous bands in an effort to achieve a multi-pronged approach to cellulite. This technology delivers radiofrequency energy using an applicator with multiple microneedles that can be customized to penetrate to different depths below the skin surface. A series of 4-6 monthly sessions is usually recommended initially when a patient is judged to be a candidate for this innovative cellulite treatment. Maintenance treatments at 12-24 months will be necessary in most cases.
SL: Breast implants. Are you for or against them? Any long-term side effects? Can cancer still be detected the same way as of a woman who is natural?
Dr. Forley: Silicone gel or saline filled breast implants provide a customizable solution to a variety of breast issues including size, sagging, asymmetry and developmental issues, and reconstruction.
Although dissatisfaction with breast size is a primary motivation in deciding to have breast implant surgery, improvement in self-esteem can be just as important for both the younger and older patient.
Post-pregnancy changes in the breasts can often cause a deflated and sagging appearance. This contributes to body image issues in combination with the changes in the appearance of the tummy after childbirth. These two problem areas are often treated by what is commonly called a “mommy makeover” in which a tummy tuck is combined with implants to replace the missing volume of the breasts. In some cases, a breast lift may also be indicated but higher profile implants can often add enough projection to lift the breasts without additional scars.
Asymmetry of the breasts can be the origin of a multitude of psychological issues that can be detrimental to the growth and development of the affected patient. Compensating for the size discrepancy with the use of implants with different volumes and dimensions in each breast can lead to a very successful resolution of this problem. In some cases, a reduction in the larger breast and an increase in the size of the smaller breast with an implant may be indicated.
Reconstruction following treatment for breast cancer can restore the appearance of the breasts with a combination of tissue expanders and implants. The process is often started at the same time as the cancer treatment and is known as immediate reconstruction.
The long-term risks specific to implants are implant deflation, capsular contracture or hardening of the breasts, and surface rippling or irregularities. These and other rare risks will be discussed during an initial consultation with your plastic surgeon. Commonly used diagnostic tools for the screening and detection of breast cancer are felt to be effective in the presence of breast implants.
SL: Is there a specific age when a person should start with non-invasive treatments meaning is it safer at a later age opposed to somebody in their 20’s?
Dr. Forley: There are a variety of non-invasive or minimally invasive treatments that offer beneficial outcomes to the aesthetic appearance of the face and body irrespective of a patient’s age. I believe a realistic expectation for improvement that coincides with the type of treatment being utilized is the key to patient satisfaction. Safety is more a function of matching the appropriate procedure to the needs of the patient than arbitrarily linking that procedure to their chronological age.
SL: Please share with us other treatments you use and recommend to your patients and differentiate who is the perfect candidate for each.
Dr. Forley: A frequent area of concern in both men and women is the effect that the appearance of their lower eyelids has on how they view themselves and how they are perceived by others. Prominent fat pads in the lower eyelid, wrinkled or poorly elastic skin, and the visible under eye circle known as the tear trough contribute to the aged and tired look associated with the baggy lower lid. Fortunately, we have excellent options for treating this problem. When the tear trough is associated with mild prominence of the fat pads, injectable filler can be used to blend the transition from the eyelid to the cheek to create a more uniform surface contour that successfully improves this early sign of aging in a minimally invasive manner.
In more advanced stages of the baggy lower eyelid, a fat transposition lower lid lift or blepharoplasty is performed. This surgical procedure is carried out through an incision on the inside of the lower eyelid so there is no visible scar. It involves first releasing the tight band responsible for creating the tear trough depression. The existing fat pads of the lower eyelid are then moved or transposed to fill the lid-cheek junction after any excess fat has been removed.
This results in a brighter and more youthful appearance to the eye that looks natural and non-surgical. Skin elasticity issues or wrinkling are often addressed with lasers or radiofrequency treatments.
SL: As always, it was a pleasure speaking with you and we look forward to interviewing again in the spring.
DR: Forley: It is my pleasure and I look forward to speaking with you again soon.
Bryan G. Forley, M. D., F.A.C.S.
5 East 82nd Street
New York, NY 10028
Plastic & Reconstructive Surgery