Are You Too Old for Plastic Surgery?

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Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.


July 02 2008

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Ask a plastic surgeon if there's an upper age limit for plastic surgery, and you better be ready to define your terms.

"There's chronological age and physiologic age," explains Darrick Antell, MD, FACS, a New York City-based plastic surgeon. "Some people might be 70 chronologically, but they're more like 50 physiologically because they work out all the time, they've got great genes, and they do all the things Mom always told them to do. Assuming that they're in good health, do they have realistic expectations? If they're not trying to look inappropriate for their age, I say go for it!"

And going for it they are. In 2007, people over the age of 50 accounted for 31% of all plastic surgery procedures done in the United States, according to the American Society for Aesthetic Plastic Surgery. That's more than 3.6 million surgical and nonsurgical procedures. With life expectancy in the U.S. now at 81 for women and 75 for men, there's an added incentive for seniors to look as good as they can for as long as they can.

Patients of all ages must meet certain criteria to be good candidates for plastic surgery. When they're in good health – no uncontrolled chronic conditions like diabetes, high blood pressure, or cardiovascular disease – with good skin elasticity and realistic expectations, motivation becomes the next major factor that plastic surgeons consider. "Whether a patient's reasons for having surgery are emotionally healthy or unhealthy can be obvious or subtle," says aesthetic plastic surgeon Laurie Casas, MD, FACS, of Glenview, IL. She gives an example of good motivation. "I don't have people coming in saying, ‘I want to look young.' I have people saying, ‘I want to look the best I can for my age.'"

She recalls just such a case earlier this year: a healthy, active 76-year-old woman whose upper eyelids were drooping to the point where they were interfering with her vision. "Under a local anesthetic with a little sedation we took the excess skin off," Dr. Casas explains. "We were very conservative so she wouldn't have any dry eye issues, but more importantly, so her eyes would match the rest of her face."

Until fairly recently, facial rejuvenation was dominated by surgical techniques like the traditional and mini-face lifts, which virtually ignored the issue of reduced facial volume that contributes greatly to the aging look that many seniors experience. But now there are nonsurgical techniques involving injectable dermal fillers and Botox® Cosmetic that address that problem.

Another is panfacial volume restoration, a technique that Dr. Casas likes for her mature patients. "By age 65 or 70, most people have lost a significant amount of facial fat and they come in with excessive skin," she explains. "I've got four 70-plus-year-olds who come in for the Sculptra revolumization process, and they're just as happy as can be because their face looks great for 70, but not pulled with all those silly lines going in all the wrong directions."

Dr. Antell agrees with the subtle approach, especially for seniors. "I tell people that plastic surgery should whisper and not scream. It concerns me when I see people who are trying to look too young because they end up looking like they went to the taxidermist," he says. "My ideal patient for rejuvenation surgery is someone who's 55 but they look like they're 65. They don't want to look 25, but they don't want to look older than they are, either."

And he concludes with the story of one patient who just wanted her face to look as young as her heart felt. "She was in her 80s, perfectly healthy and sharp as a tack," Dr. Antell recalls. "She told me right up front that she was widowed and wanted to find a younger man!"


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