Dr. Schlessinger

"We have many older people who are interested in cosmetic surgery, and who are healthy enough to undertake cosmetic surgery," Dr. Schlessinger says.

"They benefit greatly from the changes cosmetic surgery can make to their lives," he says.

A female patient, age 66, is shown before (left) and after treatment with the Fraxel re:pair laser (Solta Medical). (Photos: Joel Schlessinger, M.D.)

"The biggest challenge to the orthodoxy has come with noninvasive procedures like botulinum toxin and fillers and other laser procedures that have sparked interest in the older segment of the population," Dr. Schlessinger says.

In the right older individuals, tumescent liposuction and rejuvenation via more invasive procedures, such as fractionated CO₂ lasers, can be appropriate, he notes.

Criteria

In his own practice, Dr. Schlessinger applies more stringent criteria to eligibility for an operation when a patient reaches the age of 65. "I would put them in a higher risk category," he says. "It doesn't mean that they won't be candidates, but any potential reason to avoid doing surgery is amplified."

If patients are on medical therapies such as blood thinners or medications for cardiac conditions, it goes without saying that they are ineligible for a procedure such as liposuction or for other more invasive procedures, Dr. Schlessinger says.

"I inject botulinum toxin and other fillers routinely on patients who are on blood thinners and cardiac medications," he says.

It's crucial to get a detailed medical history and to not assume the absence of medications in a patient's history suggests optimal health, Dr. Schlessinger says.

"It could be that is the furthest thing from the truth," he says. "In many cases, they are simply avoiding physicians. They may have sky-high blood pressure that is untreated, which is why we want to be absolutely sure they are in good health before doing invasive procedures."

Paradigm shift

With the aging of the baby boomers and increased individual concerns about putting the best possible face forward, the paradigm has shifted.

"We see many people who are seeking to look the best that they can," Dr. Schlessinger says. "They find the opportunities to look better extremely exciting. It would be a true shame to not allow them to benefit from the myriad changes that we have been able to effect through cosmetic surgery in the last 20 years."

The oldest individual that Dr. Schlessinger has treated for an invasive cosmetic procedure is a 78-year-old woman who underwent tumescent liposuction, and who he describes as being in perfect health.

"She was extraordinarily happy with the results and had no medical issues before, during or after the procedure," he says.

"We did undertake a much more thorough physical examination and had her undergo an EKG prior to the procedure, and had her receive medical clearance from her physician. It goes without saying it is terribly important (to perform a thorough examination) if you are considering operating on an older individual," Dr. Schlessinger says.

Patients in their 80s can safely receive filler treatments, he notes.

"They are happy to see modest changes that many younger people would not be happy with," he says.