Am I good candidate for a ‘Gap’ procedure?

All about the ‘Gap Years’ and the ‘Triangle of Youth’

A youthful face is characterized by the ‘Triangle of Youth’. This looks like an upside-down ‘A-Frame’. In contrast, the aging face forms jowls along the jawline and becomes square-shaped at the bottom so now it can be described as a ‘right side-up’ triangle or sometimes a rectangle. The goal of any rejuvenation treatment, non-invasive, minimally invasive, or surgical is to restore the inverted ‘Triangle of Youth’.

The term ‘Gap Years’ applies to the age between a younger group with minimal aging and an older group that is seeking a surgical solution such as a facelift. Generation X (born 1965-80) and Millennials (born 1981-1996) are the groups that belong to this gap. Potential ‘Gap Group’ candidates benefits from non-surgical and minimally invasive procedures. However, in the Age of the Kardashians, older members of Generation Z (born 1997-2012) have also become consumers.  Twenty-year-old’s use Botox for expression lines and lip flips, fillers and fat injections for facial contouring. Gen Z have also adopted surgical procedures previously thought to be the exclusive preserve of older Gens, such as brow lifts.

Some cosmetic surgical procedures are not related to a specific age group but rather a lifetime event such as childbirth, breast feeding and Massive Weight Loss. Breast lifts and tummy tucks, which are common after childbirth. Body Lifts done to correct skin excess after massive weight loss. Breast augmentation with implants and breast reduction may be performed at any age after the breasts are fully developed, although breast implants are not FDA approved in the US under the age of 18. Endoscopic brow-lifts, upper and lower eyelid eyelifts, ear-pinning, upper lip-shortening, buccal fat removal, chin augmentation and rhinoplasty are all surgeries that are performed in younger age groups.

Gap patients may also have premature signs of aging so that a surgical procedure in the fifth decade, such as a face-lift can be the best option. There are no sharp demarcations. Everyone ages differently depending on facial and body characteristics, skin type, weight, exercise regimen and general lifestyle habits such as sun exposure, smoking and alcohol consumption. The typical treatments for the Gap group are Botulinum toxin (Botox), Hyaluronic acid fillers (such as Juvéderm and Voluma) and topical radiofrequency skin tightening devices such as Forma.  In the older age groups, volume loss and skin laxity can benefit from minimally invasive treatments which are able to give more dramatic and longer lasting results.  Examples are fat injections and bipolar radiofrequency treatments such as AccuTite and Morpheus8.

The effects of AccuTite and Morpheus are dependent on collagen contraction. The treatments are analogous to shrink wrapping the face. It can take up to 6 months to see final results, which are due to tissue remodeling. Morpheus treatments are done in a series of three, with the first being at the same time as an initial AccuTite treatment followed by two more treatments 30 days apart. Morpheus can be repeated every six to twelve months. AccuTite can be repeated every two to three years. In contrast, a facelift will have more or less immediate results and the duration of the result is ten or more years. Facelifting will address other problems such as extreme skin laxity and muscle banding in the neck. However, both Morpheus and AccuTite can be useful even after a facelift to tighten residual skin laxity, especially around the jawline and the angle of the mouth, and to reduce deep lines in the skin. Even patients who do not want a surgical procedure at any age can get some benefit from AccuTite and Morpheus.

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