Drs. Marissa Tenenbaum and Terry Myckatyn. photo by Taka Yanagimoto

With so many innovations in facial rejuvenation, how can someone determine which options are best? A patient’s No. 1 asset is a qualified physician, according to Drs. Terry Myckatyn and Marissa Tenenbaum, principal physicians at West County Plastic Surgeons of Washington University.

    They subscribe to a holistic approach to aging. “The old paradigm—the skin gets old, it drops, and it gets lifted again—is too simplistic,” Myckatyn says. “The skin loses some of its elasticity and its collagen becomes reorganized because of sun exposure and age,” he says. “Bones also change, with some of the bones in the middle of the face changing shape and losing projection over time.”

        Myckatyn says facial rejuvenation has been revolutionized by fillers. “When patients went from having invasive facelifts to non-invasive fillers, we found that we can get some rejuvenation from fillers,” he says. “That experience made us realize that part of the aging process is volume loss.” That’s why at their office, treatments are tailored to individual needs; no one procedure addresses every facial concern and as a patient ages, her requirements change, notes Tenenbaum. “A combination of volume restoration, skin rejuvenation and surgical tightening or sculpting may produce the most optimal result,” she says.

    For younger patients with finer wrinkles and pigmentation issues, laser technology, Botox and fillers might be better. “The way the face ages is multi-factorial,” Tenenbaum explains. “Crows feet, forehead furrows and some upper lip wrinkles can be treated with Botox, nasolabial folds with fillers; and lasers can be used to correct sun damage, acne scars or pigment changes, as well as remove unwanted facial hair.” 

    Older patients may find surgery beneficial for loose, sagging skin, Tenenbaum adds. “We often combine face and neck lifts with lower eyelid surgery, for instance, to lift the cheek pads,” she says. As people age, they lose volume in the face. “You’ll begin to see hollowing around the temples, above the eyebrows and under the eyes, and the chin may retrude.” One solution is fat grafting. “We harvest fat from the thigh or belly and use it to fill cheek pads for a fuller look. It also works to augment thin lips,” she says, adding that combining fat grafting with a facelift is not uncommon, especially if the patient is already undergoing surgery. “They complement each other: A facelift can’t do what a fat graft does, and vice-versa.”  

    While technology has improved the number of products available to aid rejuvenation efforts, Myckatyn warns that patients should thoroughly examine all the options. “The reality is, you don’t hear about the vast majority of these products after a couple of years because they don’t work,” he says. Because West County Plastic Surgeons is affiliated with Washington University, “there’s an expectation in the community—they trust that we’re going to take the time to evaluate things medically—and that’s key,” Myckatyn notes. He and Tenenbaum also belong to a panel that evaluates new technologies in cosmetic surgery. “We look for actual scientific information to make sure the technology works,” he says. “There’s a very fine line between staying ahead of the curve and making sure we’re fulfilling our role as doctors.”  

On the Cover: West County Plastic Surgeons of Washington University offers experienced and fellowship-trained cosmetic surgeons. Located at Mason Road and Olive Boulevard in Creve Coeur, the facility offers a comfortable setting and personalized treatment. For more information, call 996-8800 or visit www.westcountyplasticsurgeons.wustl.edu.