Cosmetic Surgery Over 60 and Beyond
The number of Americans over the age of 65 getting cosmetic surgery has doubled in the last 20 years, with most of the increase in the last five years, according to the American Society for Aesthetic Plastic Surgery (asaps.org). Eyelid surgery is the most popular choice, followed by facelifts. As we age our upper eyelids droop and lower eyelids bulge. This is true for almost everyone, and if the lids obstruct vision, health insurance may pay for upper eyelid surgery. But why the increase in facelifts at an age when former generations held onto their money and accepted the natural aging process with a minimum of angst?
“People are living longer than previous generations and are so much more active now,” says New York facial plastic surgeon Dr. Philip Miller, co-founder of Gotham Plastic Surgery and Associate Professor at NYU School of Medicine.
In many ways 60 really is the new 40. It’s true that with good nutrition, regular exercise, and a better understanding of our overall health men and women are keeping their bodies in shape. “Yet the aging process, the way the skin and face change, is much the same as it always has been,” notes Miller. “People look in the mirror and what they see is not how they feel. The disconnect is jarring.” People don’t necessarily want to look younger, they just want to look as good as they feel.
Dr. Manish Shah of Shah Aesthetic Surgery in Denver, Colorado, has a significant number of over 60 patients who come in wanting an “overhaul” of their face. Younger people generally start with minimally invasive procedures like chemical peels, Botox, and fillers when they are in their 30s, 40s, and 50s. These procedures are more affordable and have less down time than surgery. But for those who have not engaged in skincare or cosmetic injectables maintenance, facial surgery is probably the best option.
The most common reasons patients over 60 want a facelift, according to Shah, is because they have lost a spouse, either to death or divorce, and want to feel vital again; or because they are trying to combat ageism in the workforce, particularly in highly skilled jobs. Women, especially, seek cosmetic surgery when the caregiving years are over and they can finally afford the time and cost of doing something for themselves.
Looking better extends to creating the best smile. Orthodontic specialists are also seeing more patients over 60. Dr. Kathleen Hwang, of Hwang Orthodontics in Monrovia, California, and a member of California Association of Orthodontists caortho.org, has treated quite a few seniors who want a better smile. “One lady, 67, asked if she was being too vain having work done at this point in her life. But this is the time to pay attention to ourselves.”
Part of the trend toward more seniors having their teeth fixed is because the technology has made it easier. “Older adults don’t want to be seen in braces, but with Invisalign [clear braces], the embarrassment is minimal as teeth are being straightened or a bite corrected,” notes Hwang.
Dr. Ronald Jawor of Power Smile Specialist in Irvine, California, and Assistant Professor in the Department of Orthodontics at Loma Linda University of Dentistry, is seeing many more seniors than when he began practicing in 1969.s“Most come in with their teeth looking like a train wreck, with severely crowded teeth,” says Jawor.
In addition to finessing smiles, an orthodontic specialist might be able to do an orthognathic (jaw) surgery that would supplant the reason for cosmetic facial surgery. “Somebody with a severe under- or overbite, with either a jaw protrusion or a receding chin, should check with an orthodontist specialist first. A plastic surgeon is not going to do a jaw advancement; instead they might camouflage the problem with a chin implant,” Jawor notes. Ideally orthodontic specialists and cosmetic surgeons can work together to create the best result.
There are risks to any surgery, of course. Although a good percentage of those 60 and over are excellent candidates for surgery, older people are still more fragile medically than those in their 40s. Contra-indications for surgery include respiratory problems like asthma or COPD and high blood pressure. For a drinker, the liver may not metabolize the anesthetic well; smoking interferes with blood supply. The possibility of blood clots is a serious issue. “The biggest medication problem is blood thinners,” Miller says. Patients with a history of stroke or heart attack are not good candidates.
“A facelift is elective surgery, so there should be no tolerance for risk,” says Shah. “In addition to other risks, if the tissues don’t seem healthy, we will opt to start with low intensity procedures rather than putting someone through surgery. And we partner with the patient’s medical doctor.”
One of the biggest considerations for cosmetic surgery in Shah’s practice is that patients have a good support system. Beyond being biologically healthy with a good mindset, it is important to have a caregiver to check the drains in the first few days, and who can make sure you are taking your meds, icing for swelling and bruising, eating, and getting up and moving around when the time is right. If there is no one in the family or circle of friends who can help, Shah’s practice provides back-up caregivers. “You can’t do it by yourself.”
With all these caveats of cosmetic surgery, what is the upside to elective cosmetic surgery – besides looking fantastic. “People in their 60s and 70s are not whiners,” notes Shah. “They seem to be more pain tolerant, maybe because they have experienced more in life.”
Judy Kirkwood writes articles for print and web publications – national, regional, and local; is a contributing writer to Simply the Best and Boca Raton Observer magazines in South Florida; and plays on the beach and in the pool year-round. Visit her on Facebook @JudysFlorida and please visit www.JudysFlorida.com.