11. Perimenopause: Facial Plastic Surgery with Dr. Diana Ponsky

Facial aging involves skin laxity, facial volume loss, jawbone shortening and masculinization, and brow arch flattening over time.

Aging is a process of gravitational skin descent, fat descent, and atrophy of certain fat groups in the face.

Asian individuals are genetically predisposed to under-eye puffiness (fat accumulation) with aging, requiring fat removal rather than fat grafting.

Asian individuals are genetically predisposed to uneven skin tone and require more frequent laser treatments and chemical peels as preventive maintenance.

Within 5 years around menopause, 30% of collagen depletes, followed by 2% depletion each year thereafter.

Twin studies demonstrate that lifestyle habits (smoking, drinking, sun exposure) can create a 10-year appearance difference between identical twins.

Estrogen receptors are present throughout the skin, and circulating estrogen changes during menopause affect skin, mucosa, and hair.

Starting hormone replacement therapy earlier is a game changer for maintaining muscle mass and preventing fat redistribution from face to midsection.

Smoking contributes to lip line formation; repeated motions from straw use also exacerbate perioral wrinkles.

Smoking cessation for 4 weeks before and 4 weeks after facial surgery is required to optimize healing outcomes.

It is never too late to begin facial care; late starters may need more aggressive initial treatments (deeper lasers, fat transfer) before transitioning to maintenance programs.

Hyaluronic acid fillers volumize tissue but do not lift; adequate volumization can create an illusion of lifting.

Fillers persist longer than initially understood, can infiltrate into muscle fibers, and may restrict muscle movement, particularly affecting smile dynamics in the mid-cheek area.

Ingested collagen provides building blocks but does not directly translate to collagen production by fibroblasts in the body.

Blonde, blue-eyed individuals age faster from a skin standpoint but have better bone health than Asian individuals.

Osteoporosis occurs in facial bones (jaw, areas around nose), not just long bones; Asian individuals experience faster jaw and chin recession due to bony changes.

Blonde, blue-eyed individuals develop facial lines faster and experience more rapid skin aging even with optimal sun protection, but their cheekbones and jawbone withstand time better than Asian individuals.

Statistics suggest 30-40% of women's lives are now spent after menopause, a period without circulating estrogen leading to progressive bone density loss.

Subtherapeutic minoxidil can be used preventively to curb anticipated hair loss during perimenopause and menopause.

Pelvic floor physical therapy is beneficial after multiple vaginal deliveries to maintain pelvic floor health.

Better muscle mass (girth) aids faster recovery from injuries such as bone fractures.