Genomic, skeletal changes in older patients require cosmetic procedures addressing volume loss

MIAMI — Physiological changes in older patients often require different approaches to cosmetic procedures compared with younger patients, according to a speaker here.

“My patient population, like many in a city like Miami, is going to be a little older than the average,” Stephen H. Mandy, MD, said at South Beach Symposium 2017. “If you look at patient profiles, cosmetic patients in particular, you’ll see the average profile is somewhere between 35 and 60 [years old]; I would say mine is more like 40 to 75, or older.”

Stephen H. Mandy

Changes occur in a patient at multiple levels as they age. Genomic changes include decreased expression of genes involved in lipid biosynthesis and epidermal differentiation which contributes to the aging appearance in skin. There is also a decreased expression of collagen synthesis and increase in regulation of metalloproteinases which leads to the loss of elasticity in skin.

Skeletal changes, the loss of skeletal substructure and soft tissue, affect the orbital aperture, the glabellar angle and the maxilla and mandible. These changes affect both men and women; however, they begin much earlier in women than men, as early as mid-20’s, according to Mandy.

“Volume replacement in the older patient is critical, and I think all could attest in plastic surgery that for many, many years everything was re-draping and retightening,” Mandy said. “And what you got was a progressively tighter little bird face. If you’re dealing with large volumes of fat loss or skeletal loss, you’re going to go to a more economic filler like fat or a filler-like sculpture, because that’s what it takes to really get pan-facial filling, but what you really need at the end of the day is a structural filler like poly-L-lactic acid or a calcium hydroxylapatite.” – by Talitha Bennett

References: Mandy S. Cosmetic Approaches to the Older Patient. Presented at: South Beach Symposium 2017; Feb. 9-12, 2017; Miami Beach, Florida.

Disclosure: Healio.com was unable to determine whether Mandy has a direct financial interest in the products discussed in this article or if he is a paid consultant for any companies mentioned.