 Hi, I'm Meredith Morris, University of Maryland Medical Center. Today, we're discussing the latest anti-aging trends with Dr. Natalie Justice from University of Maryland Facial Plastic Surgery. Thanks for being here today, Dr. Justice. Thank you. Thank you so much for having me. And thanks to all of you for watching. We invite you to leave your questions in the comments section below and be sure to like this video to let us know you're tuning in. Dr. Justice, why don't you give us a little history about you and what you specialize in related to facial plastic surgery? Sure. So I just moved here to the state and also to University of Maryland. I was in residency in Boston at Masai near the Harvard program. And then that was Otolaryngology. And then I did a separate fellowship in facial plastic and reconstructive surgery at the University of Michigan. And then I just moved to the area in August with my husband, who's active duty in the Army and our 18 month old daughter. Well, welcome aboard and we're happy to have you on our team here at University of Maryland. Great so far. Great. All right, so let's get right into the questions because I know we have a lot to discuss related to the trends and anti-aging and exactly what it is we offer at University of Maryland Facial Plastic Surgery. So why don't we start off by what are the, I guess, the most common complaints or concerns you see in your practice related to aging? Sure, it's a lot of things. I think a lot of people are concerned about wrinkles that are forming as they age in the forehead, around the eyes or crow's feet. Patients are bothered by what we call increased nasolabial hold depth. So the cheek crease kind of as they age. They're bothered by jowling and discontent of the face. And then other things like texture changes, sun damage, changes to the neck. So I kind of I hear it all. Some things are more common than others and some are a little bit specific to the patient, but all kinds of things. At what age do most people begin to notice changes in their appearance? Oh, gosh, I feel like it can change a lot from patient to patient. I mean, I feel like I know this. Well, I'm probably like paying particular attention to things. I notice changes in my face in my mid 20s that bothered me, but it was nothing I would have ever done anything about. I feel like some of my patients come in in their mid to late 20s and are noticing things that they want to get ahead of. But I would say the majority of my patients are 40s, 50s, 60s, who are who are coming in for anti aging. Is visible aging preventable? Well, we're all going to age. So I think it's really the the speed at which you age and some of it, you know, genetic, some of it's based on lifestyle and other risk factors, some of which we can mitigate and improve on, some of which we can. I would say, you know, aging in general is is not preventable, but we can sort of slow the process or do a couple of things to to improve the aging process. You mentioned risk factors and also genetics. Can you go through just a short list of what some of those risk factors may be for more, I guess, premature aging? Sure, I would say that the number one is smoking. Diet and exercise can can improve the aging process, but I would say that that smoking is is the most modifiable of risk factors. So so I'm not smoking. But a lot. I mean, a very significant portion of aging is just based on our genes. So it's not really something that folks can do a whole lot about on a on a genetic level, but that's where, you know, I come in and some of the tricks that we have can can help outside of stopping smoking and maybe making sure that you're living an overall healthy lifestyle. At what point should a person begin to implement a skin care routine or possibly personalized facials based on their skin type, etc.? It's a great question. And I'm, you know, it depends on who you ask. And I think even if you asked a bunch of facial plastic surgeons, they might have different answers. For me, that question is very patient specific because I have folks that that aren't bothered by their wrinkles and, you know, it's it's a badge of honor because we're smiling and they're they're happy to have signs of aging. For other folks, they want to kind of dampen that a little bit. And so I would just say it's time to to get on it whenever it bothers you to to kind of work on some of that preventive. I mean, there's things you can do to almost push some of it off, but I would never ask or suggest for anyone to do those things until they're ready to take that step. You hear a lot about how Zoom and other video platforms have made people more hyper focused on their appearance lately. Have you seen an increase in patients or in concerns related to the fact that they are now on camera? Absolutely. I think patients notice their noses a lot more because it's central to the face and I think they can get a little bit distorted on Zoom, just like selfies can distort the nose. I think folks filter themselves more or think about that. They look at their skin more. They look at asymmetries more so from one side of the face to the other. So, yeah, I've seen and heard a lot about all of that recently. So what can they do? I mean, short of actually having a procedure done, whether it's surgical or non-surgical, are there things they can do, you know, just at home to help improve the way that they feel that they look on camera? Yeah, I mean, I would say good skin care, hydration, all that kind of stuff, but good lighting. You know, there's things that I can help with if it's a concern outside of Zoom or, you know, things that they want to address. But I think that's something that a lot of folks are dealing with right now. So I just read that a recent study by the American Academy of Facial Plastic and Reconstructive Surgery showed that surgical procedures are up and non-surgical procedures are actually down. What do you attribute that to and do you think it possibly is because they're able to, I guess, like heal behind the mask, heal more discreetly at home? Yeah, I think folks are able to heal at home. I think a lot of folks have experienced a lot more flexibility with their work schedules or they can fit something in for a change. They might be changing jobs or I just feel like I've heard all kinds of things. It's given them, you know, people are looking at themselves more on Zoom. They've thought about an intervention for a while and they've decided to go ahead and do it. But, you know, I've seen a lot of the non-surgical stuff as well. I've done a lot of Botox because of wrinkles that folks are seeing on Zoom and fillers for kind of hollowing and other concerns. So I feel like folks, I don't know. I don't know if I've noticed that there's a dramatic change in surgeries so much as people are commenting more on Zoom and are just acknowledging that change in their lives. It's interesting you mentioned rhinoplasty in particular because the study also mentioned rhinoplasty is like one of the number one surgical procedures that's increased during the pandemic. So if somebody were to have a rhinoplasty, what can they expect as far as healing time, scarring, et cetera? Yeah, that's a great question. So I do both functional, so rhinoplasty for breathing as well as cosmetic, so rhinoplasty for the shape of your nose. I think folks are coming in, you know, because they're noticing their nose more, but also potentially with the masks, they're noticing changes in their their breathing. And so I, you know, would analyze the nose if there's a deviated septum or enlarged turbinates, I can address those at the time of the septorhinoplasty. I do most of mine through what we call an open approach, which means you have a little incision right under your nose in the columnella. But that's hidden long term if it heals really well. Surgery takes a few hours and you generally go home the same day. And, you know, the kind of nuances of it I would get into with each particular patient, depending on what their concerns are, what they would like to address with surgery. But generally, I leave splints in the nose and those come out about a week later. And then from there, you know, you can go back to work probably about a week later. Some go earlier, some go later. Really depends on what you're doing for work and then also what your comfort level is, what's being asked of you once you get back to the office or wherever you're working. But yeah, I've done a lot of rhinoplasty recently. It seems to be something that people are thinking about. What other surgical and non-surgical techniques, procedures do you offer as far as anti-aging or just improving or rejuvenating your appearance? Oh, there's a lot. So in terms of non-surgical things, we can do. I do a lot of Botox for wrinkles. I do a lot of filler for the nasolabial folds or under the eyes. We have PRP here for anti-aging. We can do that with or without a micro facial. And then we have a really incredible laser. So that can be used for BBL, but also more specific laser technologies, pro fractional, other sorts of resurfacing. And then we have an esthetician here as well for other facials and anti-aging non-surgical procedures. In terms of surgery, we can do upper lids, lower lids, facelifts, rhinoplasty can be done in an anti-aging way and all kinds of other little procedures. But it's really important to me that we focus on the right procedure for a particular patient and that they understand what their options are, because you might not have all those options for a particular patient. And that's where I kind of stand in to interpret and help them decide what might be the best for them. One of the offerings you just mentioned, PRP, platelet-rich plasma. Can you explain exactly what that is? And is that a common treatment that's offered at many spots and facial plastic surgery offices? Or is that more unique to our practice? I would say we're lucky to have that technology. Not everywhere has it. It's definitely been taking off. I wrote a review article about PRP a couple of years ago, and I feel like since then, it's like even even taken off more in terms of interest and then also some of the indications for it. So PRP, we take a small vial of your blood and we spin it down in the office in a centrifuge and then we use the plasma component. And we can sort of incorporate that into a facial. We can also use it for hair loss. And for the right patient, it can help augment hair growth. So there's a lot of different ways that we can use it. But again, it kind of depends on picking the right patient so that they get the result that we expect and that they want. What is it about PRP that makes it so effective and unique? Well, it has a number of growth factors, like I can't even list them all right now, but it's kind of thought to be restorative and indicated for kind of a wide variety of things that help you to look useful again. And how many laser treatments? I know you mentioned that we have a really awesome laser at University Maryland Facial Plastic Surgery. So exactly what can the laser be used for and how many treatments would be necessary or sessions rather in order for you to see the most improvements or for it to be most effective? Yeah, this is a conversation I have with my patients all the time. I think if you're coming in with some sun damage or a little bit of redness almost like on the rosacea spectrum, I always I always see how we're going to do with the first treatment. But I let patients know and a lot of facial plastic surgeons or folks in the field will suggest doing three treatments to really get a good result. I use that first treatment to sort of determine how how much I can I can give to the skin because I mean, I did two two friends of mine recently and I thought that they would need kind of a similar amount of of the laser. But one had a kind of like robust response with even less treatment. And the other kind of didn't have as much response as I thought. And the first one ended up having like a lot of that pigmentation come out and a lot of kind of anti-aging benefits. And the other had some but but not as much. And I wouldn't have necessarily expected that just in analyzing their skin to begin with. And so we never push the laser or do anything that's outside of set protocols. But you don't always know how someone's skin is going to react until you do that first laser treatment. So now for the one friend, I would I would probably push it to the same level again or go almost as much because she had such a good anti-aging result. But for the other one, I might even push it a little bit further on the second time. But I wouldn't necessarily have known that unless I'd done a first treatment on them. And so I think it's helpful to to kind of think about it as a series of treatments because you often sort of unmask some of those benefits on the second or third treatment. But most people will notice a pretty good result from one. But then potentially want to do more. And I will say that the laser targets the skin and resurfaces. But often what I'm doing is a little bit of like the BBL, which is not technically laser, but it is laser like and then doing a bit of Botox with that for sort of a gentle rejuvenation. And the Botox targets the muscle. And so for a lot of folks, that's what they're kind of coming in for. They're feeling a little dull and stuff after all the mask wearing the past couple years and especially going into the holidays or looking for a little bit of a boost or some brightening. Speaking of Botox, it seems like people mistakenly use Botox and filler, whether it's on social media or if you're just talking with them, they'll accuse people of having Botox in possibly areas where Botox would never be used, etc. So can you explain what the difference is between Botox and filler and also how long the results last for each of them? Sure. So very simply, Botox is going to paralyze muscles. So it works by preventing muscles from moving. And it's most frequently used on the forehead, between the eyebrows, around the eyes and the crow's feet. I use Botox sometimes on the lower face, but that's mostly in patients with facial paralysis. So not on your kind of typical anti-aging patient. I think people mistakenly think sometimes that sort of that heavy lower face or that some of the changes that you see to the nasal labial fold is caused by Botox, which it usually is not. Usually we use filler, so a molecule that retains water to inject into the nasal labial folds or other areas to augment the cheeks to to work on the under eye hollows. Botox is going to take a few days to work. So you're not going to notice an immediate effect, whereas with filler, you will notice an immediate effect. But I never want my patients to have that like overdone or overfilled look. And so frequently I'm discussing the difference between the two. And then we sort of elect which one we're going to do at that visit. And then we kind of, you know, Botox takes about two weeks to hit its maximum effect. So it's not infrequently that I'm having a patient come back, check in with me at two weeks, make sure they're happy before we proceed with any filler or anything like that. I can do them both at the same time. But I feel like for a lot of my patients who are just getting into anti-aging or just getting into Botox and filler, that they might prefer to sort of see the stepwise additive effect rather than doing it all at once. Once they start these different injectables, how often would they need to come into the office to keep up with the long lasting effect of it? So you never have to come back if you don't like it or you find that it's not something that you want to do. So, you know, there's no like you're not hurting yourself by not following up with it if you don't like it for whatever reason, that being said, most patients really, really, really like it and want to come back. So the Botox, you'll usually start to notice that it's starting to wear off around three or four months. That means that some folks want to come back and get more right then. But other folks kind of like it as it wears off. You still have a lot of benefits from it. So three, four, five, six months is sort of what I would expect Botox to last. Sometimes folks only want to get it once a year or, you know, want to get it around the holidays and that's fine, too. And then filler, I find to be a little more variable. It can last six months on some folks. It can last up to a year. So it's a little a little more variable. But again, if you get it once, it doesn't mean you're committed to getting it a second time and, you know, when it when it eventually does kind of wear away, you can add more and a lot of my folks really like it and want to keep going with it. But it's totally a personal choice. Is it ever too late to start anti-aging treatment? I don't think so. You know, it's going to you're going to notice a longer term result or the changes that you make of the 20, 30, 40 year old do pay dividends later, but I don't think it's ever too late. And a lot of the things that we're doing, laser Botox, those can be done at almost any age. When people often hear facial plastic surgery, they think that it's all cosmetic related. You made a comment about how oftentimes they'll use Botox for your facial paralysis patients as well. What are some of the other conditions that you and our other facial plastic surgeon treat that would not be considered cosmetic necessarily? Yeah, that's a great question. So my fellowship and the majority of my training has been a combination of cosmetic and reconstructive surgery techniques. And even here in Maryland, I would say more of my practice is is reconstructive and cosmetic. You know, I kind of strive for that balance because I really enjoy both of them so much. Dr. Vikari and I both see cosmetic and reconstructive surgery patients. The reconstructive side of things can be skin cancer reconstruction. It can be facial nerve paralysis after a tumor or Bell's palsy, rhinoplasty that's more functional or caused by a trauma. And then I also see a lot of patients come through shot trauma with a variety of things that have happened to them where I work on their reconstruction. All right. So we're going to switch and take some questions from the audience. So the first question is Katie asks, what can I do to lift a saggy yowl and wrinkly neck? I prefer non-surgical option. That's a great question. I definitely have to see see the area. Some of our lasers can be used to tighten the neck, which can be a good benefit for the right patient. Other treatments like Kybella can help to dissolve fat in the neck. I will say the neck is a challenging place and it's where eventually if you want to get a contour restored, you're starting to think about surgical options, but I've got plenty of folks that that don't ever want to go there. And so we, you know, do what we can in the office. And if they don't ever want to go into surgery for a change to their neck, then I would never push it. But it really depends on what their results are. And if I feel like I can get a good enough benefit for them as to what I would suggest in the office, can you tell us a little bit more about Kybella? I've actually had a friend do it. She had great success, but for those watching who may not have heard of it before or are unsure of what it all involves, can you explain a little bit more? Yeah, so Kybella is a product that helps to dissolve fat in multiple different areas. But a lot of facial plastic surgeons use it for the chin. You would inject it at one time and then you get this kind of like swelling response, it's the fat dissolved. And you would think about doing two, sometimes three different injections, timelines over the course of a couple of months. And, you know, for a patient that sort of has fat that's sitting on top of the platysma, it can be a really good, nice improvement. But it really depends on having, you know, may analyze your neck and a good conversation of what the expectation would be because it's definitely about for everyone. If you have muscle banding there or, you know, other aging that's not related to fat, then it might not be the best, best procedure for you. OK, and then Amy asks, I have chin hair growing in with thick, blonde and white hair. I have been told years ago that there is no way to permanently remove blonde or white hair. Does this continue to be true? Um, so. It's harder to remove lighter hair on lighter skin or darker hair and darker skin. And it's easiest when there's a contrast between hair and skin tone. That being said, there's usually some, we have a great laser, there's usually some benefit to to using the laser for laser hair removal. And so I would have, you know, have to see you. But I think if someone's willing to try and knows that it might take, you know, a couple extra sessions or something like that, then often we can get to a better place with the laser hair removal. So we have we have two different ways of removing laser or sorry, two different ways of removing hair in the office, two different lasers. And so we'd have to talk about, you know, which one would be better for that specific patient. OK, and then our last question we received, James asks, what do you offer as far as skin care for African American men? I have been treated to help identify skin flare ups and the skin ointments have not been effective. That's a good question. I have to dive into a little bit more to what he means about flare ups, whether it's, you know, acne or another skin condition. But a lot of the, you know, procedures that we use laser Botox can be, you know, used on skin of all different colors. You just have to know where you modulate. You might use a little bit less laser or lower pulse or a different filter. But it's really important to me that we're offering procedures that that are available to a wide variety of patients. And so, you know, I'd encourage you to come in and we can look at some of those two and then also we have a great esthetician that could help with that as well. Dr. Justice, is there anything else that we haven't covered yet that you feel people should know, whether it's about facial plastic surgery, anti-aging, any other topics? I don't know. I'm, you know, excited to be here. I'm excited to meet folks in the area. So much of what we've talked about today is very specific to the patient. So I encourage you to come in and chat with me. I'll never push you to do anything you don't want to do. But I think a lot of folks don't realize some of the options that they have now. We've got a lot of really, really great technology and some of it's changed relatively recently. So it's always worth seeing if something is right for you. And yeah, I'm looking, looking forward to meeting more folks in the area. Why should patients choose the University of Maryland Facial Plastic Surgery? So I would say both my partner, Dr. Bacaria and I are both really interested in giving patients good results that don't make them feel unlike themselves. We want people to embrace their natural beauty. I think we both also deal with really complex facial reconstructive type surgeries all the time, so we're really comfortable with complex facial anatomy. And we, you know, both really enjoy the kind of whole spectrum of caring for patients with with big traumatic injuries, but then also the really delicate minutiae of caring for patients who just want to look their best and have anti-aging concerns. And, you know, we're an easily approachable duo. And we really both enjoy what we do. Why is it important for patients to choose a board certified facial plastic surgeon for their needs? Oh, my gosh, I've done so much training to get to this point. So we have done, I have done, I mean, I've done four years of medical school, four years of undergrad, then four years of medical school with a two year break where I was a teacher and then five years of residency. Some folks do even longer than that. A year of fellowship, multiple board exams. So we are we are experts in facial anatomy, the musculature. There's there's few but rare and sometimes significant sequela or adverse events from either Botox or filler administration or from using a laser improperly. And those are things that I never wanted anyone to go through. And so you reduce the risk of any of that by going to someone that's had such extensive training. And what is your patient care philosophy? I think I've addressed it a little bit. It's I want patients to look and feel their best and that's different for everyone. You know, one patient might want more extensive surgical intervention, others just might want things that turn back the clock a few years. And I really try to honestly lay out the options and then help kind of guide the patient to the decision that they think is best for them. But it's different for everyone and different patients have different questions. They want, you know, different things for me. And I try to just really be their guide through that process. For viewers who still have questions or concerns, what do you suggest is next step? Just come and see me and we'll talk about it. And where do you practice where your office location? I have offices in Baltimore. I've got a reconstructive office and a cosmetic office that are actually really close to each other, but depending on, you know, the day and what a patient needs, I can be pretty flexible. And then we also have an office in Colombia where your colleagues see these patients. Oh, yeah, Dr. Marquaria sees patients in Colombia. OK, great. All right, well, that's all the time we have today. Thank you again, Dr. Justice, for speaking with us. And thanks to all of you for watching. Again, you can continue to leave your questions for Dr. Justice in the comments section below. You can also send us a private message if you feel more comfortable asking your questions that way. And if you would like to schedule an appointment with Dr. Justice or Dr. Vicaria, you can call 667-214-1772. And we'll put that in the caption as well. And we'll talk to you guys later. So thank you again, Dr. Justice. Thank you.