Caitlin Whyte: So many of us are on the quest to look
younger and healthier. And these days, there are so many options to choose from
depending on what you're looking for. Today, we are joined by Dr. Julia Toman,
an assistant professor and Division Chief of Facial Plastics and Reconstructive
Surgery, to review what facial rejuvenation really means, explore the surgical
and non-surgical options and identify the important preventative measures to
ensure a healthy appearance.

Welcome to MD Cast by Tampa General Hospital, a go-to
listening location for specialized physician-to-physician content, and a
valuable learning tool for world-class healthcare. I'm Caitlin Whyte. Now, Dr.
Toman, start us off today with giving us a definition. What does facial
rejuvenation mean?

Dr. Toman: So, facial rejuvenation can mean a wide
variety of things. It depends on sort of what the concerns are of patients
coming into your office. So in a broad practice setting, you'll have patients
who are coming in who have gotten a little older and are starting to notice
some of those changes that we don't particularly care for as time moves on for
us. And so for those patients, you're going to have a very distinct set of
needs. But you also have patients who come in who have potentially had a
trauma. And rejuvenation for them can mean a variety of different avenues that
we have to pursue. And then, certainly, there are the patients who come in who
are younger, but are looking to maybe do some augmentation or they've never
liked sort of the way their jawline looked, for instance, and so they're
looking to sort of rejuvenate that look. I think that rejuvenation can take a
variety of different avenues for different patients. And it's really starting
the conversation out about what is bothering the patient and what do they want
to talk about.

But I think one of the most important things that I try to
convey to patients when we start this conversation is that this is really a
quality of life conversation. You know, some people come in and they're very
embarrassed because they think that this has to do with vanity. And I really
try to upfront talk about how we all engage in a society that is increasingly
full of selfies and different social media and people are often very judged by
their appearance. And, you know, we can have a sociological debate about that,
but that's the reality of how people engage in society. And quality of life
rejuvenation is incredibly important to people's both functional as how they
engage in society, getting a job, et cetera, but also how they feel about
themselves and how they put themselves out both in a professional and a social
setting.

Caitlin Whyte: No, absolutely. I 100% agree. Now,
whatever the reason, it sounds like facial rejuvenation as a term can mean so,
so many things, but does it always mean surgery?

Dr. Toman: It doesn't always mean surgery. There's a
wide variety of techniques available to us. Certainly, surgery has been a
mainstay. It existed for decades. But a lot of people come in and they're very
scared of surgery. They've seen a lot of things that have gone wrong in
surgery, right? All you have to do is turn on the TV and watch various TV shows
or look on social media about things that have gone wrong. And a lot of
patients are looking often when they come in for something that is a little
less invasive than surgery, and that's very reasonable. There are a variety of
products on the market, whether it's filler-type products where we're adding
volume to the face with those to either address early aging changes or create a
contour that a patient is looking for. There's also neurotoxins, which you
know, people are most familiar with Botox, but there's a whole slew of
different things on the market that do that same function of decreasing the
muscular movement in the face and getting rid of some of those fine dynamic
lines that some of us start to notice and want to get rid of. And so, in
addition to that, there's also some laser resurfacing that can be done for the
skin that helps to rejuvenate the appearance without surgery.

Caitlin Whyte: So, let's touch on some of the ones
you already mentioned in the non-surgical category. When we're talking about
neurotoxins and fillers, I mean, these are non-surgical, but just how easy, or
you know, what's the process like if it's non-surgical? Is it still pretty
in-and-out?

Dr. Toman: Yeah. So, these are really accessible.
It's an in-and-out. You come into the office. You are, you know, awake, you're
in the exam room. We typically will put some topical numbing just to make
people comfortable because there is a poke with a needle, but it's a very small
needle and people go back to work right after doing it. There is a small risk
of getting a small bruise, which can be covered up with makeup. There are
obviously always risks in doing these types of things, which, you know, you
have to have a conversation with your provider about. But these are very rare,
especially in the hands of someone who is experienced in doing these things.

And so, it's a really great option for people who don't have
a lot of downtime and are looking to address some early changes and just
appreciating that there is sort of a limit to what can be accomplished with
these. But for many patients, this is a fantastic option, especially as they're
easing into, you know, the conversation about rejuvenation.

Caitlin Whyte: Absolutely. And how about maybe what
people would think of as more traditional, these surgical options of facial
rejuvenation? What are our options there?

Dr. Toman: Absolutely. And so, there's a wide variety
of changes that we'll see in the face as we get more mature. A lot of patients
come in and they're concerned about the extra skin on their neck, then we also
see other changes in the contour of the face. And, you know, we go from a more
heart-shaped youthful appearance to a more square shape, which we tend to
associate with being a little older. And oftentimes people might come in and
they'll say, "Well, I just hate my neck," but really when you have a
chance to talk to them, it's, well, they also don't love their jawline and they
don't love the square shape of their face and really moving some of that volume
back from where it came over the cheekbones.

I always tell people, you know, it's good to be
comprehensive about what they want to approach. So for instance, if you do just
a necklace, because people want to inevitably be as minimalist as possible,
people want to look natural and that's a very normal thing that people are
worried about. But I'll often remind people that you wouldn't paint half a
wall, and so it's really good if we're going to go through the process of
making sure we're addressing things that won't highlight other changes if we
fail to address those. And so, I really try to be comprehensive in addressing,
you know, is it cheekbones, jawbone, neckline, you know, to the collarbones.
Are we worried about the position of the brow? Some people have varying amounts
of dissent of their brows and people complain about looking angry or like a
heavy brow is really uncomfortable. And sometimes that's something that we do
need to address with surgery because it actually allows us to lift the lower
portions of the face in a more comprehensive and ultimately more natural
appearance. When you have this incongruity between the area where you've had
facial rejuvenation surgery, the area that you don't address can actually be
even more noticeable. So, sometimes more is actually less.

Caitlin Whyte: Okay, gotcha. So before we even get to
both surgical and non-surgical options for facial rejuvenation, are there
preventative measures that people can be doing, you know, now just to take care
of their appearance and keep it up to what they want?

Dr. Toman: Absolutely. And you know, a lot of this
comes down to prevention. Certainly, we are all at the mercy of our genes and
our various exposures that we've had, but something as simple as making sure
that you're wearing sunscreen and a hat when you're outside. Photo damage is a
huge player in aging of the skin, and so I always tell people, regardless of
what you want to do down the line, you know, a good skin protection routine
should be the base of everything that you're doing, and you can never start too
early. I see patients in their 20s and I tell them, "You have to be using
sunscreen. Please stop, you know, exposing your skin." We all love that
golden glow, but it's not going to serve you well in the long run.

Caitlin Whyte: Absolutely. I know I've been getting
pretty on top of my skincare routine in my sunscreen as well. Well, wrapping up
here, doctor, you mentioned age, and that's my last question here. When should
someone start the process of facial rejuvenation, if that's something they're
worried about?

Dr. Toman: Yeah. And that's something that's variable
for a lot of different patients. I tell people the time to do something is when
it bothers you enough to do something about it. And for some people, you know,
they start noticing changes in their even mid-30s, and that's a great
opportunity to start with something that's maybe a little less invasive, start masking
some of those changes. And for some people, that's in their late 70s, they come
in and, you know, they have a, you know, change in their life circumstances.
They're out on the dating scene again, and they just want to look refreshed,
and that's when it's bothered them enough to do something about it. So, it's
all about meeting people where they are and with the specific needs that they
have coming up with a tailored approach just for them.

Caitlin Whyte: Well, such a great conversation,
doctor. Thank you so much for your time today, and thank you for listening to
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